MEDICARE: SANTURCE PHARMACEUTICAL CORP

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	332BX2000X	Oxygen Equipment & Supplies (DME)	05-P-2123	PR
2	333600000X	Pharmacy	07-F-2129	PR

General Provider Information

NPI Number	:	1659340628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTURCE PHARMACEUTICAL CORP

Provider Business Mailing Address
First Line	:	547 CALLE ESCORIAL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-4706
Country	:	US
Telephone Number	:	787-782-7113
Fax Number	:	787-774-1479

Provider Business Practice Location Address
First Line	:	547 CALLE ESCORIAL
Second Line	:	CAPARRA HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-4706
Country	:	US
Telephone Number	:	787-782-7113
Fax Number	:	787-774-1479

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. JOMAR GALINDEZ
Credential	:
Telephone Number	:	787-782-7113

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/20/2010

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