Healthcare Provider Details

I. General information

NPI: 1457581506
Provider Name (Legal Business Name): FARMACIA SAN LUCAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO ANTIGUA AREA DE CONSERVACION
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 7064
PONCE PR
00732-7064
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-812-3488
Mailing address:
  • Phone: 787-843-4185
  • Fax: 787-812-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-2975
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberFPE-00002-17
License Number StatePR

VIII. Authorized Official

Name: MRS. ISUANET CASTILLO
Title or Position: DIRECTORA EJECUTIVA OPERACIONAL
Credential: CPA
Phone: 787-843-4185