Healthcare Provider Details

I. General information

NPI: 1447398847
Provider Name (Legal Business Name): TU FARMACIA FAMILIAR LILLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARCELO STREET 17
MAUNABO PR
00707
US

IV. Provider business mailing address

BOX 66
MAUNABO PR
00707
US

V. Phone/Fax

Practice location:
  • Phone: 787-861-4855
  • Fax: 787-861-1056
Mailing address:
  • Phone: 787-861-4855
  • Fax: 787-861-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07F1864
License Number StatePR

VIII. Authorized Official

Name: MRS. LILLIAN T MARRERO
Title or Position: PRESIDENT
Credential:
Phone: 787-861-4855