Healthcare Provider Details

I. General information

NPI: 1063892032
Provider Name (Legal Business Name): GOOD SHEPHERD PHARMACY DBA MEDS DIRECT RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 459 KM 0.5 LOTE 2 CALLE GREGORIO SANDERS LA MONTANA INDUSTRIAL PARK
AGUADILLA PR
00605
US

IV. Provider business mailing address

PO BOX 250423
AGUADILLA PR
00604-0423
US

V. Phone/Fax

Practice location:
  • Phone: 787-335-5400
  • Fax:
Mailing address:
  • Phone: 787-335-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number17-F-3299
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number17-F-3299
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number17-F-3299
License Number StatePR

VIII. Authorized Official

Name: MIGUEL A FIGUEROA
Title or Position: PRESIDENT
Credential:
Phone: 787-335-5400