Healthcare Provider Details

I. General information

NPI: 1609116508
Provider Name (Legal Business Name): DAMAR OF PUERTO RICO SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. INDUSTRIAL REPARADA LOTE A-2
PONCE PR
00732
US

IV. Provider business mailing address

P.O. BOX 25130
SAN JUAN PR
00928-5130
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-3946
  • Fax: 787-841-7101
Mailing address:
  • Phone: 786-547-3240
  • Fax:

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-3113
License Number StatePR

VIII. Authorized Official

Name: DANIEL MAHIQUES
Title or Position: PRESIDENT
Credential: DOCTOR IN PHARM
Phone: 787-396-8165