Healthcare Provider Details

I. General information

NPI: 1457418774
Provider Name (Legal Business Name): FARMACIA LOURDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 123 STE 14
PONCE PR
00728
US

IV. Provider business mailing address

14 CARR 123
PONCE PR
00728-2708
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-1314
  • Fax: 787-842-8185
Mailing address:
  • Phone: 787-842-1314
  • Fax: 787-842-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURA I LOPEZ
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 787-242-7822