Healthcare Provider Details

I. General information

NPI: 1538200894
Provider Name (Legal Business Name): FARMACIA GLADYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE RAMON RIOS ROMON STE 112 B
SABANA SECA PR
00952
US

IV. Provider business mailing address

PO BOX 388
SABANA SECA PR
00952-0388
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-1562
  • Fax: 787-784-0716
Mailing address:
  • Phone: 787-795-1562
  • Fax: 787-784-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-0265
License Number StatePR

VIII. Authorized Official

Name: GLADYS ALICEA COSME
Title or Position: VP
Credential:
Phone: 787-795-1562