Healthcare Provider Details

I. General information

NPI: 1093879405
Provider Name (Legal Business Name): INTERNATIONAL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 AVE SAN LUIS
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 2087
ARECIBO PR
00613-2087
US

V. Phone/Fax

Practice location:
  • Phone: 787-986-0227
  • Fax: 787-834-9408
Mailing address:
  • Phone: 787-878-4348
  • Fax: 787-878-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10-F-2454
License Number StatePR

VIII. Authorized Official

Name: LIZZETTE RUIZ
Title or Position: GENERAL MANAGER
Credential:
Phone: 787-986-0227