Healthcare Provider Details

I. General information

NPI: 1114011871
Provider Name (Legal Business Name): FARMACIA DEL POZO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 KM, 2.8- INT 668 BDA. CORDOVA DAVILA
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1068
MANATI PR
00674-1068
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-2041
  • Fax: 787-884-9039
Mailing address:
  • Phone: 787-854-2041
  • Fax: 787-884-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13F2941
License Number StatePR

VIII. Authorized Official

Name: MR. STEVE RAYMOND SOTO
Title or Position: PRESIDENT
Credential: MA
Phone: 787-854-2041