Healthcare Provider Details

I. General information

NPI: 1467583328
Provider Name (Legal Business Name): DAMAR OF PUERTO RICO SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CERRA 900 FINAL
SANTURCE PR
00907-5104
US

IV. Provider business mailing address

PO BOX 25130
SAN JUAN PR
00928-5130
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-4600
  • Fax: 787-723-4068
Mailing address:
  • Phone: 787-722-4600
  • Fax: 787-723-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-3157
License Number StatePR

VIII. Authorized Official

Name: ALLAN CAO
Title or Position: ADMINSTRATOR
Credential: PHARMACIST
Phone: 786-547-3240