Healthcare Provider Details

I. General information

NPI: 1811147424
Provider Name (Legal Business Name): FARMACIA SANDUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ZUSURREAGUI ESQUINA 1 ABRIL
MARICAO PR
00606
US

IV. Provider business mailing address

HC 5 BOX 36735 BRISAS DEL RIO SONADOR
SAN SEBASTIAN PUERTO RICO
00685
UM

V. Phone/Fax

Practice location:
  • Phone: 787-450-0672
  • Fax:
Mailing address:
  • Phone: 787-450-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANCY QUILES
Title or Position: AUXILIAR DE FARMACIA
Credential:
Phone: 787-450-0672