Healthcare Provider Details

I. General information

NPI: 1477638914
Provider Name (Legal Business Name): MEDICAL PHARMACY & LABORATORY ADMINISTRATIVE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FLOR ANTILLANA RES LUIS LLORENS TORRED
SAN JUAN PR
00923
US

IV. Provider business mailing address

PO BOX 51991
TOA BAJA PR
00950-1991
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-5550
  • Fax:
Mailing address:
  • Phone: 787-707-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL ROBLEDO GOMEZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-707-1943