Healthcare Provider Details

I. General information

NPI: 1174611735
Provider Name (Legal Business Name): SU FARMACIA AMIGA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LAS AMERICAS BU-1 RES BAIROA
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 1861
CAGUAS PR
00726-1861
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-6434
  • Fax: 787-745-5660
Mailing address:
  • Phone: 787-743-6434
  • Fax: 787-745-5660

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 Number20-F-3196
License Number StatePR

VIII. Authorized Official

Name: POLITA TORRES
Title or Position: OWNER
Credential: PHARMACIST
Phone: 787-743-6434