Healthcare Provider Details

I. General information

NPI: 1841361243
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY LA PAZ PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 62.7 BO SABANA HOYOS SECTOR CANDELARIA
ARECIBO PR
00612
US

IV. Provider business mailing address

CALLE JOSE RODRIGUEZ IRIZARRY #152
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-881-2440
  • Fax: 787-880-3258
Mailing address:
  • Phone: 787-881-2440
  • Fax: 787-880-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F2302
License Number StatePR

VIII. Authorized Official

Name: MR. LUIS R MONROUZEAU
Title or Position: OWNER PRESIDENT
Credential: MBA HCM
Phone: 787-878-1548