Healthcare Provider Details

I. General information

NPI: 1649362195
Provider Name (Legal Business Name): FARMACIA PRYMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 149 KM 13
CIALES PR
00638
US

IV. Provider business mailing address

PO BOX 1427
CIALES PR
00638-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0601
  • Fax: 787-871-3960
Mailing address:
  • Phone: 787-871-0601
  • Fax: 787-871-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number16F326
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number16F326
License Number StatePR

VIII. Authorized Official

Name: MRS. GLADYS RIVERA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-871-0601