Healthcare Provider Details

I. General information

NPI: 1366570574
Provider Name (Legal Business Name): FARMACIA HOSPITAL AUXILIO MUTUO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PONCE DE LEON 715 PDA. 37.5
HATO REY PR
00919
US

IV. Provider business mailing address

PO BOX 191227
SAN JUAN PR
00919-1227
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F0327
License Number StatePR

VIII. Authorized Official

Name: ILIA MELENDEZ
Title or Position: MANAGER
Credential:
Phone: 787-758-2000