Healthcare Provider Details

I. General information

NPI: 1548977069
Provider Name (Legal Business Name): PHARMA ANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIDALGO 148-A SAN ANTONIO TLAYACAPAN
CHAPALA JALISCO
45922
MX

IV. Provider business mailing address

HIDALGO 148-A SAN ANTONIO TLAYACAPAN
CHAPALA JALISCO
45922
MX

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MISS ANA RENTERIA ZAZUETA
Title or Position: OWNER
Credential: MBA
Phone: 888-449-7799