Healthcare Provider Details

I. General information

NPI: 1952653776
Provider Name (Legal Business Name): FARMACIA SAGRADO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ANGEL G. MARTINEZ 3
SABANA GRANDE PR
00637
US

IV. Provider business mailing address

PO BOX 539
SABANA GRANDE PR
00637-0539
US

V. Phone/Fax

Practice location:
  • Phone: 939-910-7920
  • Fax: 939-910-7921
Mailing address:
  • Phone: 939-910-7920
  • Fax: 939-910-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ILIANETTE MIRANDA
Title or Position: PRESIDENT
Credential: RPH.
Phone: 787-448-5914