Healthcare Provider Details

I. General information

NPI: 1326145848
Provider Name (Legal Business Name): SANTIAGO R VARELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SAN ANTONIO #17
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 144 CALLE SAN ANTONIO #17
ANASCO PR
00610-0144
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-4120
  • Fax: 787-826-6738
Mailing address:
  • Phone: 787-826-4400
  • Fax: 787-826-6738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number07F1287
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number07F1287
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number07F1287
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1314290002
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-1287
License Number StatePR

VIII. Authorized Official

Name: MR. SANTIAGO R. VARELA
Title or Position: OWNER
Credential:
Phone: 787-826-4120