Healthcare Provider Details

I. General information

NPI: 1245274554
Provider Name (Legal Business Name): FARMACIA CENTRO MEDICO WILMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 39 5 ALGARRPBP CALL BX 7001
VEGA BAJA PR
00694
US

IV. Provider business mailing address

CARR 2 KM 39 5 ALGARRPBP CALL BX 7001
VEGA BAJA PR
00694
US

V. Phone/Fax

Practice location:
  • Phone: 787-858-1580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07F0263
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LUIS ROSA
Title or Position: COMPTROLLER
Credential:
Phone: 787-858-1580