Healthcare Provider Details

I. General information

NPI: 1578772356
Provider Name (Legal Business Name): MEDICAL PHARMACY AND LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/21/2007

III. Provider practice location address

AVENIDA ANDGLUCIA 771 PUERTO NUEVO
SAN JUAN PR
00921-1803
US

IV. Provider business mailing address

771 AVE ANDALUCIA
PUERTO NUEVO PR
00921-1803
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-1943
  • Fax: 787-706-8823
Mailing address:
  • Phone: 787-707-1983
  • Fax: 787-706-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. MIGUEL A ROBLEDO
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-707-1983