Healthcare Provider Details

I. General information

NPI: 1578714382
Provider Name (Legal Business Name): EMPRESAS CORDERO BADILLO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESMERALDA, ESQ CALLE D BO. FRAILES
CATANO PR
00963
US

IV. Provider business mailing address

PO BOX 458
CATANO PR
00963-0458
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-1825
  • Fax: 787-789-1826
Mailing address:
  • Phone: 787-789-1825
  • Fax: 787-789-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09F2550
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINNETTE VALLELLANES
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 787-638-8955