Healthcare Provider Details

I. General information

NPI: 1649898172
Provider Name (Legal Business Name): LUIS EMANUEL MOJICA TECNICHIAN PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS EMANUEL MOJICA TECNICHIAN PHARMACY

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/03/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. PR 3 KM 9.5 AVE. 65 DE INFANTERIA
CAROLINA PR
00985
US

IV. Provider business mailing address

BO. MALPICA SECT. MONTE BELLO
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-2900
  • Fax:
Mailing address:
  • Phone: 787-223-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number12992
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: