Healthcare Provider Details

I. General information

NPI: 1609931427
Provider Name (Legal Business Name): FARMACIA BRISAS DEL MAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CALLE 2 BRISAS DEL MAR
LUQUILLO PR
00773-2463
US

IV. Provider business mailing address

901 CALLE 2 BRISAS DEL MAR
LUQUILLO PR
00773-2463
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-4880
  • Fax: 787-889-0410
Mailing address:
  • Phone: 787-889-4880
  • Fax: 787-889-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAF3151191
License Number StatePR

VIII. Authorized Official

Name: ANA IRIS DE LA CRUZ PADILLA
Title or Position: MANAGER
Credential:
Phone: 17878894880