Healthcare Provider Details

I. General information

NPI: 1962543348
Provider Name (Legal Business Name): VIRNA L MARTINEZ COLON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMPO ALEGRE CARR 130 KM 11.6
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 142275
ARECIBO PR
00614-2275
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-9861
  • Fax:
Mailing address:
  • Phone: 787-898-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08-F-2353
License Number StatePR

VIII. Authorized Official

Name: MRS. VIRNA L MARTINEZ
Title or Position: CHIEF PHARMACIST
Credential: BSPH
Phone: 787-898-8616