Healthcare Provider Details

I. General information

NPI: 1699763326
Provider Name (Legal Business Name): FARMACIA SAN JOSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE SAN JOSE
LARES PR
00669-2432
US

IV. Provider business mailing address

3 CALLE SAN JOSE
LARES PR
00669-2432
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-1500
  • Fax: 787-897-2655
Mailing address:
  • Phone: 787-897-1500
  • Fax: 787-897-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier039390100
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name: MR. FRANCISCO L JIMENEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-454-6473