Healthcare Provider Details

I. General information

NPI: 1215071915
Provider Name (Legal Business Name): MVC SALES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 30 UU 48 STA JUANITA
BAYAMON PR
00956-4789
US

IV. Provider business mailing address

CALLE 30 UU 48 STA JUANITA
BAYAMON PR
00956-4789
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-0755
  • Fax: 787-787-6557
Mailing address:
  • Phone: 787-786-0755
  • Fax: 787-787-6557

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 Number17-F-0001
License Number StatePR

VIII. Authorized Official

Name: MAGDA COUSO
Title or Position: OWNER
Credential:
Phone: 787-786-0755