Healthcare Provider Details

I. General information

NPI: 1982615522
Provider Name (Legal Business Name): PHARMAEXTRA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUNOZ RIVERA 56 SOUTH
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 372830
CAYEY PR
00737-2830
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-5343
  • Fax: 787-263-2883
Mailing address:
  • Phone: 787-738-5343
  • Fax: 787-263-2883

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 TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18F2690
License Number StatePR

VIII. Authorized Official

Name: ELLIOT PACHECO BEAUCHAMP
Title or Position: CEO
Credential: MBA
Phone: 787-738-5343