Healthcare Provider Details

I. General information

NPI: 1386979672
Provider Name (Legal Business Name): FARMACIA EL BUEN PASTOR 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 420 KM 2.2 BARRIO VOLADORAS
MOCA PR
00676
US

IV. Provider business mailing address

HC 4 BOX 13792
MOCA PR
00676-9750
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-9922
  • Fax: 787-877-7284
Mailing address:
  • Phone: 787-877-9922
  • Fax: 787-877-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier037673400
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer
# 2
Identifier2122119
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: LUIS PEREZ SOTO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-299-6927