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General NPI Number Information
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NPI Number | 1073816427
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Entity Type | Organization
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Legal Business Name | DLR CONDADO PHARMACY
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 186 CALLE JUAN P DUARTE HATO REY
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City | SAN JUAN
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State | PR
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Zip | 00917-3602
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Country | US
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Telephone | 787-758-0168
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Fax | 787-753-5906
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Provider Business Mailing Address
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Address Line | PO BOX 195417
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City | SAN JUAN
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State | PR
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Zip | 00919-5417
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Country | US
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Telephone | 787-758-0168
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Fax | 787-753-5906
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Authorized Official
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Title or Position | TREASURER
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Name | MANUEL DE LEON
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Credential |
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Telephone | 787-758-0138
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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 | 15F2783
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License Number State | PR
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