Healthcare Provider Details

I. General information

NPI: 1417090382
Provider Name (Legal Business Name): A.CORDERO BADILLO,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 ROAD KM 8 DORADO DEL MAR SHP CNTR
DORADO PR
00646
US

IV. Provider business mailing address

PO BOX 458
CATANO PR
00963-0458
US

V. Phone/Fax

Practice location:
  • Phone: 787-278-6011
  • Fax: 787-278-6012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11F2319
License Number StatePR

VIII. Authorized Official

Name: LINNETTE VALLELLANES
Title or Position: PHCY DIR
Credential:
Phone: 787-638-8955