Healthcare Provider Details

I. General information

NPI: 1013034313
Provider Name (Legal Business Name): VIDOT RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/02/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CENTRO COMERCIAL VISTA AZUL
ARCIBO PR
00612
US

IV. Provider business mailing address

PO BOX 140358
ARECIBO PR
00614-0358
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-1800
  • Fax: 787-878-8042
Mailing address:
  • Phone: 787-878-1800
  • Fax: 787-878-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15F0494
License Number StatePR

VIII. Authorized Official

Name: MS. JACQUELINE VIDOT
Title or Position: REGISTERED PHARMACIST
Credential: RPH
Phone: 757-346-7801