Healthcare Provider Details

I. General information

NPI: 1780724740
Provider Name (Legal Business Name): FARMACIA JOBOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8395 AVE JOBOS
ISABELA PR
00662-2179
US

IV. Provider business mailing address

PO BOX 795
ISABELA PR
00662-0795
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-3660
  • Fax: 787-830-2297
Mailing address:
  • Phone: 787-872-3660
  • Fax: 787-830-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-1766
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WANDA GONZALEZ
Title or Position: PHARMACIST
Credential:
Phone: 787-872-3660