Healthcare Provider Details

I. General information

NPI: 1184997280
Provider Name (Legal Business Name): GOOD SHEPHERD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 368 KM 0.8 PLAZA ISABELLA BO. MACHUCHAL
SABANA GRANDE PR
00637
US

IV. Provider business mailing address

PO BOX 1505
SABANA GRANDE PR
00637-3505
US

V. Phone/Fax

Practice location:
  • Phone: 787-978-7300
  • Fax: 787-978-7302
Mailing address:
  • Phone: 787-978-7300
  • Fax: 787-978-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number16F3031
License Number StatePR

VIII. Authorized Official

Name: MIGUEL FIGUEROA
Title or Position: PRESIDENT
Credential:
Phone: 214-888-8099