MEDICARE: CENTRO ARARAT 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
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	18F3415	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2166530	OTHER		PK

General Provider Information

NPI Number	:	1962946426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO ARARAT INC

Provider Business Mailing Address
First Line	:	PO BOX 8730
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0730
Country	:	US
Telephone Number	:	787-705-3900
Fax Number	:	787-727-2140

Provider Business Practice Location Address
First Line	:	1507 CALLE PROF AUGUSTO RODRIGUE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2214
Country	:	US
Telephone Number	:	787-705-3900
Fax Number	:	787-727-2140

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	IVAN MELENDEZ
Credential	:
Telephone Number	:	787-284-4488

Provider Enumeration Date	:	12/18/2016
Last Update Date	:	02/23/2017

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Directions to “CENTRO ARARAT INC ” Practice Location

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