Healthcare Provider Details

I. General information

NPI: 1639309545
Provider Name (Legal Business Name): FARMACIA LA ROSA DE SARON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CALLE UMBRAL VILLA TOLEDO
ARECIBO PR
00612-9689
US

IV. Provider business mailing address

132 CALLE UMBRAL URB VILLA TOLEDO
ARECIBO PR
00612-9689
US

V. Phone/Fax

Practice location:
  • Phone: 787-817-4747
  • Fax: 787-817-4646
Mailing address:
  • Phone: 787-817-4747
  • Fax: 787-817-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-2744
License Number StatePR

VIII. Authorized Official

Name: IVIS GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-226-1770