Healthcare Provider Details

I. General information

NPI: 1790796365
Provider Name (Legal Business Name): KIRIE ENTERPRISE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 848 KM 4.2 PLAZA 66 BO. SAN ANTON
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 29775
SAN JUAN PR
00929-0775
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-4366
  • Fax: 787-768-4367
Mailing address:
  • Phone: 787-768-4366
  • Fax: 787-768-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18F2367
License Number StatePR

VIII. Authorized Official

Name: RAFAEL RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 787-768-4366