Healthcare Provider Details

I. General information

NPI: 1962861153
Provider Name (Legal Business Name): LOS PAISANOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CALLE CUPEY GDNS STE 1E
CUPEY PR
00926-7341
US

IV. Provider business mailing address

200 CALLE CUPEY GDNS STE 1E
CUPEY PR
00926-7341
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-1212
  • Fax: 787-761-1255
Mailing address:
  • Phone: 787-761-1212
  • Fax: 787-761-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4756547
License Number StatePR

VIII. Authorized Official

Name: TARIK HAMID
Title or Position: ADMINISTRATION
Credential:
Phone: 787-761-1212