Healthcare Provider Details

I. General information

NPI: 1790136059
Provider Name (Legal Business Name): ABC UNLIMITED PHARMACY SERVICES, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP STE 607
PONCE PR
00717-1379
US

IV. Provider business mailing address

655 AVE SAN PATRICIO URB SUMMIT HILLS
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-1212
  • Fax: 787-841-1149
Mailing address:
  • Phone: 939-204-1991
  • Fax: 939-204-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number18-F-3352
License Number StatePR

VIII. Authorized Official

Name: DR. EDNA M COLON
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 787-460-5378