=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013034313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIDOT RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 06/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 CENTRO COMERCIAL VISTA AZUL
-----------------------------------------------------
City | ARCIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-1800
-----------------------------------------------------
Fax | 787-878-8042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 140358
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00614-0358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-1800
-----------------------------------------------------
Fax | 787-878-8042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED PHARMACIST
-----------------------------------------------------
Name | MS. JACQUELINE VIDOT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 757-346-7801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 15F0494
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------