Healthcare Provider Details

I. General information

NPI: 1932185824
Provider Name (Legal Business Name): FARMACIA EL TUQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 CALLE RAMOS ANTONINI EL TUQUE
PONCE PR
00728-4806
US

IV. Provider business mailing address

553 CALLE RAMOS ANTONINI PARC EL TUQUE
PONCE PR
00728-4806
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2805
  • Fax: 787-841-5551
Mailing address:
  • Phone: 787-844-2805
  • Fax: 787-841-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number06-F-2252
License Number StatePR

VIII. Authorized Official

Name: DR. WALDEMAR J NIEVES
Title or Position: PRESIDENT
Credential: PHARM D.
Phone: 787-844-2805