Healthcare Provider Details

I. General information

NPI: 1124170980
Provider Name (Legal Business Name): KR CANOVANAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 185 KM.5.5 BO. CAMPO RICO
CANOVANAS PR
00729
US

IV. Provider business mailing address

CALLE SANTIAGO 61 N
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-2571
  • Fax: 787-886-7613
Mailing address:
  • Phone: 787-876-2571
  • Fax: 787-886-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F2113
License Number StatePR

VIII. Authorized Official

Name: RASMI RASHID
Title or Position: MANAGER
Credential:
Phone: 787-876-2571