=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154617181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ART PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2011
-----------------------------------------------------
Last Update Date | 06/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. JOSE DE DIEGO 87 SUITE 108 VILLAS DE SAN FRANCISCO PLAZA II
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-777-1860
-----------------------------------------------------
Fax | 787-777-1861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AVE. JOSE DE DIEGO 87 SUITE 108 VILLAS DE SAN FRANCISCO PLAZA II
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-777-1860
-----------------------------------------------------
Fax | 787-777-1861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAFAEL E RUEDA
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 787-777-1860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 13-F-2951
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------