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General NPI Number Information
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NPI Number | 1073661633
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Entity Type | Organization
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Legal Business Name | DRUG SHOPPE INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | CALLE SAN JOSE STE 59
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City | AIBONITO
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State | PR
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Zip | 00705
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Country | US
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Telephone | 787-735-2401
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Fax | 787-735-2500
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Provider Business Mailing Address
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Address Line | PO BOX 2021
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City | AIBONITO
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State | PR
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Zip | 00705-2021
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Country | US
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Telephone | 787-735-2401
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Fax | 787-735-2500
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Authorized Official
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Title or Position | OWNER PHCST
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Name | RAFAEL OLIVENCIA
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Credential |
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Telephone | 787-735-2401
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 17-F-3257
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License Number State | PR
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