Healthcare Provider Details

I. General information

NPI: 1619002037
Provider Name (Legal Business Name): FARMACIA CENTRO RENAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 AVE LOS CORAZONES SUITE 103
MAYAGUEZ PR
00680-7042
US

IV. Provider business mailing address

1050 AVE LOS CORAZONES SUITE 103
MAYAGUEZ PR
00680-7042
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-0600
  • Fax: 787-265-0670
Mailing address:
  • Phone: 787-831-0600
  • Fax: 787-265-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F1234
License Number StatePR

VIII. Authorized Official

Name: MRS. MINERVA DE SANTIAGO
Title or Position: PHARMACIST
Credential:
Phone: 787-831-0600