Healthcare Provider Details

I. General information

NPI: 1356408389
Provider Name (Legal Business Name): FARMACIA NUEVO CONCEPTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CALIFORNIA ST
QUEBRADILLAS PR
00678-0957
US

IV. Provider business mailing address

PO BOX 957
QUEBRADILLAS PR
00678-0957
US

V. Phone/Fax

Practice location:
  • Phone: 787-895-3060
  • Fax: 787-895-1804
Mailing address:
  • Phone: 787-895-3060
  • Fax: 787-895-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07F0004
License Number StatePR

VIII. Authorized Official

Name: MRS. AWILDA RIOLLANO CHICO
Title or Position: OWNER PHARMACIST
Credential: LCDA
Phone: 787-895-3060