Healthcare Provider Details

I. General information

NPI: 1356375471
Provider Name (Legal Business Name): FARMACIA SANTA JUANITA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WA1A AVE SANTA JUANITA URB. SANTA JUANITA
BAYAMON PR
00956-5074
US

IV. Provider business mailing address

PO BOX 19870
SAN JUAN PR
00910-1870
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-2554
  • Fax:
Mailing address:
  • Phone: 787-786-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07-F-2185
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number07-F-2185
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number07-F-2185
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number07-F-2185
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-2185
License Number StatePR

VIII. Authorized Official

Name: MRS. MONTSERRAT SWENSEN
Title or Position: PRESIDENT
Credential:
Phone: 787-786-2554