Healthcare Provider Details

I. General information

NPI: 1912371576
Provider Name (Legal Business Name): LUQUILLO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CALLE FERNANDEZ GARCIA LOCAL 1 LUQUILLO PLAZA
LUQUILLO PR
00773-2236
US

IV. Provider business mailing address

AA12 CALLE BAUHINIA STE 1
CANOVANAS PR
00729-3551
US

V. Phone/Fax

Practice location:
  • Phone: 787-355-7100
  • Fax: 787-355-7052
Mailing address:
  • Phone: 787-355-7100
  • Fax: 787-355-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17F3318
License Number StatePR

VIII. Authorized Official

Name: RASMI RASHID
Title or Position: OWNER
Credential:
Phone: 787-355-7100