Healthcare Provider Details

I. General information

NPI: 1043131980
Provider Name (Legal Business Name): FARMACIA MIA BLVD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. BOULEVARD, NUM. J-2725, URB. LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

100 PLAZA PRADERA ST 20 PMB 161
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-330-0240
  • Fax:
Mailing address:
  • Phone: 787-330-0240
  • Fax: 787-330-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SONIMAR B MUNIZ ROSARIO
Title or Position: OWNER
Credential:
Phone: 787-640-8183