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General NPI Number Information
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NPI Number | 1124125554
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Entity Type | Organization
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Legal Business Name | FARMACIA CORALIS INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | CARR. 867 KM 4.5 BO. INGENIO
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City | TOA BAJA
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-794-3939
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Fax | 787-794-0504
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Provider Business Mailing Address
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Address Line | PO BOX 1731
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City | TOA BAJA
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State | PR
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Zip | 00951
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Country | US
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Telephone | 787-794-3939
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Fax | 787-794-0504
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Authorized Official
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Title or Position | ADMINISTRADOR
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Name | BADER JABER
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Credential |
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Telephone | 787-602-1732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 336C0003X
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License Number State | PR
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