Healthcare Provider Details

I. General information

NPI: 1831241512
Provider Name (Legal Business Name): TOA ALTA PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 865 KM 1.3 BO CAMPANILLA
TOA BAJA PR
00949-5393
US

IV. Provider business mailing address

CARR 865 KM 1.3 BO CAMPANILLA
TOA BAJA PR
00949-5393
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-1434
  • Fax: 787-870-0169
Mailing address:
  • Phone: 787-870-1434
  • Fax: 787-870-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F2188
License Number StatePR

VIII. Authorized Official

Name: MARIA S MARRERO
Title or Position: PRESIDENT
Credential:
Phone: 787-870-1434