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General NPI Number Information
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NPI Number | 1144320938
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Entity Type | Organization
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Legal Business Name | SUPER FARMACIA AMERICA
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | AVE. LAURO PINERO # 266
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City | CEIBA
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State | PR
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Zip | 00735
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Country | US
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Telephone | 787-885-3010
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Fax | 787-885-1595
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Provider Business Mailing Address
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Address Line | 266 AVE LAURO PINERO SUITE 244
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City | CEIBA
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State | PR
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Zip | 00735-2706
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Country | US
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Telephone | 787-885-3010
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Fax | 787-885-1595
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Authorized Official
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Title or Position | OWNER
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Name | MYRNA GOMEZ
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Credential |
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Telephone | 787-885-3010
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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 | 002372
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License Number State | PR
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