Healthcare Provider Details

I. General information

NPI: 1306932389
Provider Name (Legal Business Name): FARMACIA FELICIANO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. JARDINES DE YABUCOA CALLE 1 A-8
YABUCOA PR
00767-0490
US

IV. Provider business mailing address

PO BOX 490
YABUCOA PR
00767-0490
US

V. Phone/Fax

Practice location:
  • Phone: 787-893-6709
  • Fax: 787-266-6505
Mailing address:
  • Phone: 787-893-6709
  • Fax: 787-266-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4013859
License Number StatePR

VIII. Authorized Official

Name: MS. CARMEN E. FELICIANO
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 787-893-6709