Healthcare Provider Details

I. General information

NPI: 1043375546
Provider Name (Legal Business Name): NUESTRA FARMACIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CALLE COLON
AGUADA PR
00602
US

IV. Provider business mailing address

90 CALLE COLON
AGUADA PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-2300
  • Fax: 787-252-0436
Mailing address:
  • Phone: 787-868-2300
  • Fax: 787-252-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F0472
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS M RUIZ
Title or Position: CEO
Credential:
Phone: 787-868-2300