Healthcare Provider Details

I. General information

NPI: 1336386960
Provider Name (Legal Business Name): FARMACIA SANTA JUANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W PLAZA MALL LOCAL A BO PUEBLO CARR. 156
CAGUAS PR
00725
US

IV. Provider business mailing address

27 CALLE REGINA MEDINA CONDOMINIO ATRIUM PARK APT B807
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-3503
  • Fax: 787-745-2001
Mailing address:
  • Phone: 939-339-7353
  • Fax: 787-653-0939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11-F-2694
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE GERARDO CRUZ
Title or Position: OWNER/PHARMACIST
Credential: PHARM D
Phone: 787-414-9738