Healthcare Provider Details

I. General information

NPI: 1073590873
Provider Name (Legal Business Name): FARMACIA GABRIELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 132 KM 22.1 BO. RIO CANAS
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 800670
COTO LAUREL PR
00780-0670
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-1953
  • Fax: 787-290-1953
Mailing address:
  • Phone: 787-290-1963
  • Fax: 787-290-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11-F-1932
License Number StatePR

VIII. Authorized Official

Name: DR. RICHARD SOLER
Title or Position: OWNER
Credential: M.D.
Phone: 787-844-4958