Healthcare Provider Details

I. General information

NPI: 1790812154
Provider Name (Legal Business Name): FARMACIA CDT LARES MED CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAR 111 AVE KM 2 9
LARES PR
00669
US

IV. Provider business mailing address

PO BOX 1427
LARES PR
00669-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-1499
  • Fax: 787-897-1463
Mailing address:
  • Phone: 787-897-1499
  • Fax: 787-897-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number11F1738
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BALTSAR CRUZ
Title or Position: PRES
Credential: MD
Phone: 787-897-1444