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General NPI Number Information
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NPI Number | 1053523100
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Entity Type | Organization
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Legal Business Name | FARMACIA DE MARIANAS
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 543 CHALAN GUMAYUOS
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City | TAMUNING
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State | GU
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Zip | 96913
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Country | US
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Telephone | 671-646-9696
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Fax | 671-649-6601
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Provider Business Mailing Address
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Address Line | PO BOX 8718
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City | TAMUNING
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State | GU
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Zip | 96932
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Country | US
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Telephone | 671-646-9696
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Fax | 671-649-6601
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MRS. MARIA LUZ BALUYOT GUZMAN
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Credential | REGISTERED PHARMACIS
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Telephone | 671-646-9696
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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 | PCY004
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License Number State | GU
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