Healthcare Provider Details

I. General information

NPI: 1083756415
Provider Name (Legal Business Name): FARMACIA SAN MIGUEL ARCANGEL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE A.R.BARCELO
UTUADO PR
00641-2949
US

IV. Provider business mailing address

38 CALLE BARCELO
UTUADO PR
00641-2878
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-2118
  • Fax: 787-894-2038
Mailing address:
  • Phone: 787-894-2118
  • Fax: 787-894-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18F3228
License Number StatePR

VIII. Authorized Official

Name: VICTOR DIAZ
Title or Position: PRESIDENT
Credential: RPH
Phone: 787-894-2118