Healthcare Provider Details

I. General information

NPI: 1538138540
Provider Name (Legal Business Name): FAMILY PHARMACY CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CALLE 65 INFANTERIA
ANASCO PR
00610-2909
US

IV. Provider business mailing address

67 CALLE 65 INFANTERIA
ANASCO PR
00610-2909
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-2545
  • Fax:
Mailing address:
  • Phone: 787-826-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4641560001
License Number StatePR

VIII. Authorized Official

Name: MR. FRANK RIVERA
Title or Position: OWNER
Credential:
Phone: 787-826-2545