Healthcare Provider Details

I. General information

NPI: 1275752438
Provider Name (Legal Business Name): FARMACIA EXPRESO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 KM 21.8 BO.CALLEJONES
LARES PR
00669
US

IV. Provider business mailing address

CARRETERA 129 KM 21.8 BO.CALLEJONES
LARES PR
00669
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-3945
  • Fax:
Mailing address:
  • Phone: 787-897-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-1171
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier4020195
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerNABP

VIII. Authorized Official

Name: JORGE LUIS ACEVEDO
Title or Position: OWNER
Credential: PHARMACIST
Phone: 787-897-3945