MEDICARE: FARMACIA MILLA DE ORO

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	183500000X	Pharmacist	12F2886	PR

General Provider Information

NPI Number	:	1750690426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA MILLA DE ORO

Provider Business Mailing Address
First Line	:	AVE PONCE DE LEON
Second Line	:	455
City	:	SAN JUAN
State	:	PR
Zip	:	00915-3959
Country	:	US
Telephone Number	:	787-294-6242
Fax Number	:	787-294-6246

Provider Business Practice Location Address
First Line	:	AVE PONCE DE LEON
Second Line	:	455
City	:	SAN JUAN
State	:	PR
Zip	:	00915-3959
Country	:	US
Telephone Number	:	787-294-6242
Fax Number	:	787-294-6246

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HECTOR R CRUZ
Credential	:	RPH
Telephone Number	:	787-507-7041

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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