Healthcare Provider Details

I. General information

NPI: 1740261668
Provider Name (Legal Business Name): FARMACIA DOMENECH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON # 228
AGUADA PR
00602-3166
US

IV. Provider business mailing address

CALLE COLON # 228
AGUADA PR
00602-3166
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-2135
  • Fax: 787-868-2933
Mailing address:
  • Phone: 787-868-2135
  • Fax: 787-868-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18-F-3200
License Number StatePR

VIII. Authorized Official

Name: RAMON ORTIZ
Title or Position: OWNER/PHARM
Credential:
Phone: 787-868-2135