Healthcare Provider Details

I. General information

NPI: 1073644571
Provider Name (Legal Business Name): FARMACIA DEL CARMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CALLE MANUEL CORCHADO JUARBE
ISABELA PR
00662-2622
US

IV. Provider business mailing address

89 CALLE MANUEL CORCHADO JUARBE
ISABELA PR
00662-2622
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-4777
  • Fax: 787-872-4777
Mailing address:
  • Phone: 787-872-4777
  • Fax: 787-872-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F2011
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier4016449
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerNABP

VIII. Authorized Official

Name: MRS. SAUDHI E MORALES
Title or Position: OWNER
Credential: RPH
Phone: 787-872-4777