Healthcare Provider Details

I. General information

NPI: 1588897581
Provider Name (Legal Business Name): SANDUT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 435 INT. 433 KM 4.1 CALABAZAS
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 2 BOX 9504
LAS MARIAS PR
00670-9024
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1111
  • Fax: 787-280-4188
Mailing address:
  • Phone: 787-896-1111
  • Fax: 787-280-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11-F-2755
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4026921
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: MRS. NATIVIDAD DUMONT-BONILLA
Title or Position: PRESIDENT
Credential:
Phone: 787-896-1111