Healthcare Provider Details

I. General information

NPI: 1417138967
Provider Name (Legal Business Name): EMUN MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB ATENAS J9 CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1099
MANATI PR
00674-1099
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5551
  • Fax: 787-884-3835
Mailing address:
  • Phone: 787-884-5551
  • Fax: 787-884-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15F2504
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier2087573
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: NELSON ORTIZ
Title or Position: PRESIDENT
Credential:
Phone: 787-850-3793