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General NPI Number Information
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NPI Number | 1184146219
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Entity Type | Organization
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Legal Business Name | PUEBLO INC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 652 AVE MUNOZ RIVERA STE 200
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City | SAN JUAN
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State | PR
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Zip | 00918-4257
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Country | US
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Telephone | 787-754-8087
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Fax | 787-754-0983
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Provider Business Mailing Address
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Address Line | P.O. BOX 1967
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City | CAROLINA
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State | PR
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Zip | 00984-1967
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Country | US
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Telephone | 787-754-8087
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Fax |
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | MACBETH RAMOS
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Credential |
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Telephone | 787-231-8547
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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 | 19-F-3526
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License Number State | PR
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