Healthcare Provider Details

I. General information

NPI: 1831666437
Provider Name (Legal Business Name): PUEBLO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALTURAS DE TORRIMAR AVE SANTA ANA ESQ CALLE 2
GUAYNABO PR
00966
US

IV. Provider business mailing address

PO BOX 1967
CAROLINA PR
00984-1967
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-1196
  • Fax: 787-272-3776
Mailing address:
  • Phone: 787-757-3131
  • Fax: 787-793-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUIS M. MALDONADO
Title or Position: VP FINANCE
Credential: CPA
Phone: 787-757-3131