Healthcare Provider Details

I. General information

NPI: 1114249539
Provider Name (Legal Business Name): PHARMAMED PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MAGUEYES CARR. # 140 KM 63.4
BARCELONETA PR
00617-0627
US

IV. Provider business mailing address

PO BOX 627
BARCELONETA PR
00617-0627
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-7100
  • Fax: 787-846-7101
Mailing address:
  • Phone: 787-846-7100
  • Fax: 787-846-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number11-F-2529
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LUIS VIRELLA
Title or Position: OWNER
Credential:
Phone: 787-319-3153