MEDICARE: FARMACIA LA NUEVA CANDELARIA, LLC.

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
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1639963382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA LA NUEVA CANDELARIA, LLC.

Provider Business Mailing Address
First Line	:	68 CALLE RAMOS ANTONINI E
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4929
Country	:	US
Telephone Number	:	787-986-7533
Fax Number	:	787-827-7319

Provider Business Practice Location Address
First Line	:	68 CALLE RAMOS ANTONINI E
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4929
Country	:	US
Telephone Number	:	787-986-7533
Fax Number	:	787-827-7319

Authorized Official
Title or Position	:	CEO
Name	:	DR. EDGAR RIVERA
Credential	:	PHARMD
Telephone Number	:	787-986-7533

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/11/2025

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