MEDICARE: MR. HECTOR RUBEN CRUZ PHARMACIST

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	003098	PR

General Provider Information

NPI Number	:	1750694485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR RUBEN CRUZ PHARMACIST

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	:	787-620-9610
Fax Number	:	787-765-6768

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	:	787-620-9610
Fax Number	:	787-765-6768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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