Healthcare Provider Details

I. General information

NPI: 1609823269
Provider Name (Legal Business Name): CENTRAL DRUG JM CO. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE JESUS T PINERO 1304 CAPARRA TERR
SAN JUAN PR
00921-1508
US

IV. Provider business mailing address

AVE JESUS T PINERO 1304 CAPARRA TERR
SAN JUAN PR
00921-1508
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-9855
  • Fax: 787-782-7995
Mailing address:
  • Phone: 787-783-9855
  • Fax: 787-782-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1153160001
License Number StatePR

VIII. Authorized Official

Name: MR. JOSSUE ANTONIO GALGUERA
Title or Position: PRESIDENT
Credential:
Phone: 787-783-9855