Healthcare Provider Details

I. General information

NPI: 1952446825
Provider Name (Legal Business Name): FARMACIA SAN RAFAEL SANTURCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 CALLE LAFAYETTE PDA 20
SAN JUAN PR
00909-2627
US

IV. Provider business mailing address

851 CALLE LAFAYETTE PDA 20
SAN JUAN PR
00909-2627
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-3333
  • Fax: 787-721-4165
Mailing address:
  • Phone: 787-724-3333
  • Fax: 787-721-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-2298
License Number StatePR

VIII. Authorized Official

Name: MR. RAFAEL ANGEL DIAZ REYES
Title or Position: ADMINISTRATOR
Credential: PH T.
Phone: 787-724-3333