Healthcare Provider Details

I. General information

NPI: 1164508503
Provider Name (Legal Business Name): FARMACIA SAN ANTONIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1521
VILLALBA PR
00766-1521
US

IV. Provider business mailing address

PO BOX 1521
VILLALBA PR
00766-1521
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-1096
  • Fax: 787-847-6781
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07-F-1893
License Number StatePR

VIII. Authorized Official

Name: LUCIMAR ALVARADO
Title or Position: MANAGER
Credential:
Phone: 787-847-1096