Healthcare Provider Details

I. General information

NPI: 1689886392
Provider Name (Legal Business Name): COMPANIA SERVICIOS MULTIPLES LA COMERIENA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CALLE GEORGETTI
COMERIO PR
00782-2537
US

IV. Provider business mailing address

40 CALLE GEORGETTI
COMERIO PR
00782-2537
US

V. Phone/Fax

Practice location:
  • Phone: 787-875-2411
  • Fax: 787-875-2245
Mailing address:
  • Phone: 787-875-2411
  • Fax: 787-875-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09F2002
License Number StatePR

VIII. Authorized Official

Name: MR. LUIS A A FUENTES
Title or Position: FARMACIST
Credential:
Phone: 787-875-2411