Healthcare Provider Details

I. General information

NPI: 1477720266
Provider Name (Legal Business Name): RESTO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

J 24 AVE BLVD ESQ MIREYA
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 51518
TOA BAJA PR
00950-1518
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-8400
  • Fax: 787-784-8402
Mailing address:
  • Phone: 787-784-8400
  • Fax: 787-784-8402

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 Code3336S0011X
TaxonomySpecialty Pharmacy
License Number12F2605
License Number StatePR

VIII. Authorized Official

Name: MRS. MARIBEL LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-784-8400