Healthcare Provider Details

I. General information

NPI: 1003134602
Provider Name (Legal Business Name): CENTRO ARARAT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA STE 410 COND SAN VICENTE
PONCE PR
00717-1567
US

IV. Provider business mailing address

8169 CALLE CONCORDIA STE 412 COND. SAN VICENTE
PONCE PR
00717-1567
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-4488
  • Fax: 787-284-4445
Mailing address:
  • Phone: 787-284-4488
  • Fax: 787-284-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number20-F-2842
License Number StatePR

VIII. Authorized Official

Name: JUAN RIVERA
Title or Position: CEO
Credential: PHARM.D.
Phone: 787-284-5884