Healthcare Provider Details

I. General information

NPI: 1770564460
Provider Name (Legal Business Name): BARRANGUITAS DRUG CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 156 KM 16.8 SECTOR EL PORTON
BARRANQUITAS PR
00794
US

IV. Provider business mailing address

PO BOX 879
BARRANQUITAS PR
00794-0879
US

V. Phone/Fax

Practice location:
  • Phone: 787-857-3035
  • Fax: 787-857-4093
Mailing address:
  • Phone: 787-857-3035
  • Fax: 787-857-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18F3021
License Number StatePR

VIII. Authorized Official

Name: JOSE HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-857-3035