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General NPI Number Information
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NPI Number | 1033246806
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DRUG 1
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | B35 CALLE 6 URB SANFERNANDO
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City | TOA ALTA
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State | PR
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Zip | 00953-2205
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Country | US
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Telephone | 787-870-2935
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51666
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City | TOA BAJA
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State | PR
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Zip | 00950-1666
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Country | US
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Telephone | 787-870-0978
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NILZA IRIS SANTIAGO
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Credential | PHARMACIST
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Telephone | 787-870-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 15-F-0813
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License Number State | PR
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