Healthcare Provider Details

I. General information

NPI: 1720145238
Provider Name (Legal Business Name): FARMACIA PONTEZUELA 24 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C 9 AVE PONTEZUELA VISTAMAR COND GOLDEN TOWER
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 29619
SAN JUAN PR
00929-0619
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-5240
  • Fax: 787-757-0021
Mailing address:
  • Phone: 787-769-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18-F-2889
License Number StatePR

VIII. Authorized Official

Name: JOSE SANCHEZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-769-5240