Healthcare Provider Details

I. General information

NPI: 1386887990
Provider Name (Legal Business Name): MEDICAL PHARMACY AND LABORATORY ADMINISTRATIVE SERCIVE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 AVE ANDALUCIA
SAN JUAN PR
00921-1803
US

IV. Provider business mailing address

PO BOX 51991
TOA BAJA PR
00950-1991
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StatePR

VIII. Authorized Official

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