Healthcare Provider Details

I. General information

NPI: 1013067339
Provider Name (Legal Business Name): FARMACIA UNIVERSAL EJD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 AVE L MUNOZ MARIN STE 105
CAGUAS PR
00725-4080
US

IV. Provider business mailing address

80 AVE L MUNOZ MARIN STE 105
CAGUAS PR
00725-4080
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-6849
  • Fax: 787-743-6849
Mailing address:
  • Phone: 787-743-6849
  • Fax: 787-743-6849

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 Number14F2599
License Number StatePR

VIII. Authorized Official

Name: DIANNA MATAR
Title or Position: OWNER
Credential: RPH
Phone: 787-743-6849