Healthcare Provider Details

I. General information

NPI: 1528050192
Provider Name (Legal Business Name): FARMACIA DEL CONDADO, INC CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H18 CALLE JOSE VILLARES CONDADO
CAGUAS PR
00725-2463
US

IV. Provider business mailing address

H18 CALLE JOSE VILLARES CONDADO
CAGUAS PR
00725-2463
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-0001
  • Fax: 787-743-0001
Mailing address:
  • Phone: 787-743-0001
  • Fax: 787-743-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1184760001
License Number StatePR

VIII. Authorized Official

Name: GLORIVETTE SENERIZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-743-0001