Healthcare Provider Details

I. General information

NPI: 1053648618
Provider Name (Legal Business Name): FARMACIA MEDICAL PLAZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #1 BARRIO TURABO CONSOLIDATED MALL LOCAL C 31C
CAGUAS PR
00725
US

IV. Provider business mailing address

HC 8 BOX 39533
CAGUAS PR
00725-9671
US

V. Phone/Fax

Practice location:
  • Phone: 787-286-1694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11-F-2774
License Number StatePR

VIII. Authorized Official

Name: DARYLIS PIRIS
Title or Position: PHARMACY TECHNICIAN
Credential:
Phone: 787-286-1694