Healthcare Provider Details

I. General information

NPI: 1942322573
Provider Name (Legal Business Name): FARMACIA EL COMBATE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 3301 KM 2.0 SECTOR EL COMBATE
BOQUERON PR
00622
US

IV. Provider business mailing address

PO BOX 1291
BOQUERON PR
00622-1291
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-8123
  • Fax: 787-851-8129
Mailing address:
  • Phone: 787-851-8123
  • Fax: 787-851-8129

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 Number18-F-2673
License Number StatePR

VIII. Authorized Official

Name: DAVID JIMENEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-851-8120