Healthcare Provider Details

I. General information

NPI: 1194882415
Provider Name (Legal Business Name): FARMACIA MEDINA NUMER 3 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE COMANDANTE ESQ CAMP RICO
CAROLINA PR
00984
US

IV. Provider business mailing address

PO BOX 3420
CAROLINA PR
00984-3420
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-5111
  • Fax: 787-257-3585
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number16F2658
License Number StatePR

VIII. Authorized Official

Name: SAMUEL MEDINA
Title or Position: PRESIDENT
Credential:
Phone: 787-438-4798