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NPI Code Detail

MEDICARE: FARMACIA SAN RAFAEL SANTURCE, INC.

MEDICARE: FARMACIA SAN RAFAEL SANTURCE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336S0011XSpecialty Pharmacy17-F-2298PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12144222OTHERPK

General Provider Information

NPI Number : 1417371303
Entity Type Code : Organization
Provider Name (Legal Business Name) : FARMACIA SAN RAFAEL SANTURCE, INC.
Provider Business Mailing Address
First Line : PO BOX 19791
Second Line :
City : SAN JUAN
State : PR
Zip : 00910-1791
Country : US
Telephone Number : 787-724-3307
Fax Number : 787-919-7058
Provider Business Practice Location Address
First Line : 851 CALLE LAFAYETTE
Second Line :
City : SAN JUAN
State : PR
Zip : 00909-2627
Country : US
Telephone Number : 787-724-3307
Fax Number : 787-919-7058
Authorized Official
Title or Position : PRESIDENT
Name : RAFAEL DIAZ REYES
Credential :
Telephone Number : 787-724-3307
Provider Enumeration Date : 02/12/2014
Last Update Date : 04/19/2022

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