Healthcare Provider Details

I. General information

NPI: 1407932346
Provider Name (Legal Business Name): FARMACIA CDT GMSP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA CRUZ MARGINAL C-17
BAYAMON PR
00961
US

IV. Provider business mailing address

C17 CALLE MARGINAL
BAYAMON PR
00961-6706
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-1325
  • Fax: 787-778-2280
Mailing address:
  • Phone: 787-786-1325
  • Fax: 787-778-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number18-F-3386
License Number StatePR

VIII. Authorized Official

Name: DIANNETTE MALDONADO
Title or Position: FACULTAD MEDICA
Credential:
Phone: 787-780-9196