Healthcare Provider Details

I. General information

NPI: 1114027141
Provider Name (Legal Business Name): SAN ARCANGEL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE MUNOZ RIVERA
CAGUAS PR
00725-2603
US

IV. Provider business mailing address

PO BOX 863
CAGUAS PR
00726-0863
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-3400
  • Fax: 787-258-3400
Mailing address:
  • Phone: 787-744-3400
  • Fax: 787-258-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07-F-0258
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4015207
License Number StatePR

VIII. Authorized Official

Name: MRS. LILLIAN QUINTERO
Title or Position: PRESIDENT
Credential: R. PH.
Phone: 787-744-3400