Healthcare Provider Details

I. General information

NPI: 1053457648
Provider Name (Legal Business Name): LILLIAM MAGALY CARINO PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARMACIA VENUS GARDENS AVE ACUARIOI SUITE 16 VENUS PLAZA ST
SAN JUAN PR
00926
US

IV. Provider business mailing address

CONDOMINIO VEREDAS DEL RIO APT C123
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-4990
  • Fax: 787-748-1935
Mailing address:
  • Phone: 787-762-5647
  • Fax: 787-748-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5227
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: