Healthcare Provider Details

I. General information

NPI: 1962536763
Provider Name (Legal Business Name): FARMACIA ANNETTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CABRERA DEVELOPMENT LOTE 5 BO SALTO ARRIBA
UTUADO PR
00641
US

IV. Provider business mailing address

PO BOX 9415
BAYAMON PR
00960-9415
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-6555
  • Fax:
Mailing address:
  • Phone: 787-894-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. EFRAIN SIERRA
Title or Position: PRESIDENT
Credential:
Phone: 787-894-6555