Healthcare Provider Details

I. General information

NPI: 1619281599
Provider Name (Legal Business Name): ED S PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD 307 KM 4.8
BOQUERON PR
00622
US

IV. Provider business mailing address

PO BOX 1790
BOQUERON PR
00622-1790
US

V. Phone/Fax

Practice location:
  • Phone: 787-255-0485
  • Fax: 787-255-0486
Mailing address:
  • Phone: 787-255-0485
  • Fax: 787-255-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12-F-2870
License Number StatePR

VIII. Authorized Official

Name: EDGARDO CARMONA
Title or Position: PHARMACY MANAGER
Credential:
Phone: 787-381-5471