=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164648127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA DEL CONDADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB QUINONEZ JIMENEZ AVE JOSE VILLARES SOLAR #1
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-743-0001
-----------------------------------------------------
Fax | 787-286-2516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB QUINONEZ JIMENEZ AVE JOSE VILLARES SOLAR #1
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-743-0001
-----------------------------------------------------
Fax | 787-286-2516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRADORA
-----------------------------------------------------
Name | ZOE PEREZ
-----------------------------------------------------
Credential | AUX.DE FARMACIA
-----------------------------------------------------
Telephone | 787-743-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 08-F-2449
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------