Healthcare Provider Details

I. General information

NPI: 1700961679
Provider Name (Legal Business Name): FARMACIA CDT POLICLINICA SAN PEDRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CALLE MORSE
ARROYO PR
00714-2350
US

IV. Provider business mailing address

PO BOX 818
ARROYO PR
00714-0818
US

V. Phone/Fax

Practice location:
  • Phone: 787-839-3980
  • Fax: 787-271-1016
Mailing address:
  • Phone: 787-839-3980
  • Fax: 787-271-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-2194
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE SANDALIO RIVERA
Title or Position: OWNER
Credential:
Phone: 787-839-3980