Healthcare Provider Details

I. General information

NPI: 1891841680
Provider Name (Legal Business Name): COLON TAVAREZ PHARMACY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA MONSERRATE AL1 URBANIZACION VILLA FONTANA
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 6017
CAROLINA PR
00984-6017
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-0455
  • Fax: 787-752-2562
Mailing address:
  • Phone: 787-276-0455
  • Fax: 787-752-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F1317
License Number StatePR

VIII. Authorized Official

Name: MR. LUIS G COLON
Title or Position: VP
Credential: RPH
Phone: 787-276-0455