Healthcare Provider Details

I. General information

NPI: 1073524641
Provider Name (Legal Business Name): EXPRESS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARR 459
AGUADILLA PR
00603-6200
US

IV. Provider business mailing address

HC 9 BOX 13327
AGUADILLA PR
00603-9027
US

V. Phone/Fax

Practice location:
  • Phone: 787-891-5151
  • Fax: 787-891-5151
Mailing address:
  • Phone: 787-891-5151
  • Fax: 787-891-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number18-F-2393
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CARMENCITA NIEVES
Title or Position: OWNER
Credential:
Phone: 787-891-5151