Healthcare Provider Details

I. General information

NPI: 1699807560
Provider Name (Legal Business Name): SUPER FARMACIA LA ECONOMIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SIERRA BAYAMON BLOQUE 28 NO. 20 AVE. GILBERTO CONCEPCION DE GRACIA
BAYAMON PR
00961-4329
US

IV. Provider business mailing address

URB. SIERRA BAYAMON BLOQUE 28 NO. 20 AVE. GILBERTO CONCEPCION DE GRACIA
BAYAMON PR
00961-4329
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-9610
  • Fax: 787-786-9610
Mailing address:
  • Phone: 787-786-9610
  • Fax: 787-786-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09-F-1639
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ENEIDA AYALA
Title or Position: OWNER
Credential:
Phone: 787-786-9610