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General NPI Number Information
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NPI Number | 1013052307
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Entity Type | Organization
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Legal Business Name | FARMACIA DE JESUS
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27 CALLE MUNOZ RIVERA ESQ. BARCELO
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City | TOA ALTA
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State | PR
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Zip | 00954
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Country | US
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Telephone | 787-870-0993
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Fax | 787-870-0993
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Provider Business Mailing Address
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Address Line | PO BOX 1331
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City | TOA ALTA
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State | PR
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Zip | 00954-1331
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Country | US
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Telephone | 787-870-0993
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Fax | 787-870-0993
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Authorized Official
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Title or Position | OWNER
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Name | HECTOR EDGARDO DE JESUS
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Credential |
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Telephone | 787-870-0993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 07-F-0279
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License Number State | PR
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