Healthcare Provider Details

I. General information

NPI: 1003989831
Provider Name (Legal Business Name): FARMACIA DORAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/21/2022
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CALLE SAN ROBERTO, STE 101
SAN JUAN PR
00926-2758
UM

IV. Provider business mailing address

3200 LAKE EMMA RD. SUITE 1000
LAKE MARY FL
32746
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-7200
  • Fax: 787-779-1430
Mailing address:
  • Phone: 855-733-3126
  • Fax: 888-315-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5022620001
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number18-F-2882
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number18-F-2882
License Number StatePR

VIII. Authorized Official

Name: DEBRA J COLE
Title or Position: VICE PRESIDENT
Credential:
Phone: 855-733-3126