Healthcare Provider Details

I. General information

NPI: 1992850176
Provider Name (Legal Business Name): FARMACIAS MARILYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SANTA ANA 233A BO.COCO
SALINAS PR
00751
US

IV. Provider business mailing address

PO BOX 3030
YAUCO PR
00698-3030
US

V. Phone/Fax

Practice location:
  • Phone: 787-824-2617
  • Fax: 787-824-2800
Mailing address:
  • Phone: 787-824-2617
  • Fax: 787-853-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number08-F-2245
License Number StatePR

VIII. Authorized Official

Name: DR. MARILYN VEGA
Title or Position: OWNER
Credential: PHARMD
Phone: 787-824-2617