Healthcare Provider Details

I. General information

NPI: 1801290747
Provider Name (Legal Business Name): DAMAR OF PUERTO RICO SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FLOR ANTILLANA RES. LUIS LLORENS TORRES
SANTURCE PR
00907
US

IV. Provider business mailing address

PO BOX 25130
SAN JUAN PR
00928-5130
US

V. Phone/Fax

Practice location:
  • Phone: 787-982-8300
  • Fax: 787-982-8300
Mailing address:
  • Phone: 787-982-8300
  • Fax: 787-982-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17-F-3155
License Number StatePR

VIII. Authorized Official

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