Healthcare Provider Details

I. General information

NPI: 1629107677
Provider Name (Legal Business Name): SUPER FARMACIA SANTA TERESA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PIMENTEL # 17
RIO GRANDE PR
00745
US

IV. Provider business mailing address

P.O. BOX 756
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-887-2475
  • Fax: 787-888-1033
Mailing address:
  • Phone: 787-887-2475
  • Fax: 787-887-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-0773
License Number StatePR

VIII. Authorized Official

Name: MILCA JIMENEZ
Title or Position: MANAGER
Credential:
Phone: 787-887-2475