=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043348055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA JUDITH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 07/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | G30 CALLE MYRNA VAZQUEZ URB. VALLE TOLIMA
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00727-2337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-258-1177
-----------------------------------------------------
Fax | 787-745-8470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE MYRNA VAZQUEZ G-30 URB. VALLE TOLIMA
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-258-1177
-----------------------------------------------------
Fax | 787-745-8470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHARMACIST
-----------------------------------------------------
Name | MRS. ELBA HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-258-1177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------