Healthcare Provider Details

I. General information

NPI: 1467469643
Provider Name (Legal Business Name): ISLAND INFUSION PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CALLE ARZUAGA
SAN JUAN PR
00925-3718
US

IV. Provider business mailing address

ST ARZUAGA #108 ESQ. MONSENOR
SAN JUAN PR
00928
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-2626
  • Fax:
Mailing address:
  • Phone: 787-767-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: EDGARDO HERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 787-767-2626