Healthcare Provider Details

I. General information

NPI: 1083695423
Provider Name (Legal Business Name): PK INDUSTRIES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 12/30/2025
Certification Date:
Deactivation Date: 10/15/2025
Reactivation Date: 12/30/2025

III. Provider practice location address

AVE APOLO CENTRO COMERCIAL APOLO LOCAL 9
GUAYNABO PR
00969
US

IV. Provider business mailing address

3 AVE RUIZ SOLER JARDINES DE CAPARRA
BAYAMON PR
00959-7841
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-3685
  • Fax: 787-272-0746
Mailing address:
  • Phone: 787-798-2500
  • Fax: 787-787-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number07-F-1675
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number04-P-1951
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07-F-1675
License Number StatePR

VIII. Authorized Official

Name: MR. JAIME JOSE INFANZON
Title or Position: MANAGER
Credential:
Phone: 787-798-2500