Healthcare Provider Details

I. General information

NPI: 1720185655
Provider Name (Legal Business Name): FARMACIA EL DIVINO NINO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 110 KM 10.5 835 CONCEPCION VERA
MOCA PR
00676
US

IV. Provider business mailing address

835 CALLE CONCEPCION VERA
MOCA PR
00676-5016
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-4839
  • Fax: 787-877-8129
Mailing address:
  • Phone: 787-818-4839
  • Fax: 787-877-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-2289
License Number StatePR

VIII. Authorized Official

Name: XOCHITL RIVERA
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 787-818-4839