=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043483753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABC PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2008
-----------------------------------------------------
Last Update Date | 05/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 AVE DE DIEGO STE 55
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-5812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-763-8996
-----------------------------------------------------
Fax | 787-753-7322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 AVE DE DIEGO STE 55
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-5812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-763-8996
-----------------------------------------------------
Fax | 787-753-7322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEJANDRO AMADOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-763-8996
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 18-F-2593
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------