Healthcare Provider Details

I. General information

NPI: 1528279262
Provider Name (Legal Business Name): FARMACIA CLETS CENTRO MEDICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARMACIA CLETS CENTRO MEDICO PASEO JOSE C. BARBOSA BO. MONACILLOS
SAN JUAN PR
00936-8184
US

IV. Provider business mailing address

FARMACIA CLETS CENTRO MEDICO PO BOX 70184
SAN JUAN PR
00936-8184
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8118
  • Fax: 787-754-8127
Mailing address:
  • Phone: 787-754-8118
  • Fax: 787-754-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number07-F-0314
License Number StatePR

VIII. Authorized Official

Name: LOURDES MILAGROS FORMES
Title or Position: REGENT PHARMACIST
Credential: RPH,MPH
Phone: 787-754-8118