Healthcare Provider Details

I. General information

NPI: 1588741284
Provider Name (Legal Business Name): JMR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALDERON MUJICA 65
CANOVANAS PR
00729
US

IV. Provider business mailing address

CALDERON MUJICA 65
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-2150
  • Fax: 787-256-3420
Mailing address:
  • Phone: 787-876-2150
  • Fax: 787-256-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-1736
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUAN MATOS
Title or Position: OWNER
Credential:
Phone: 787-876-2150