=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184740037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA GLENVIEW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 07/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ROAD 14 AVE TITO CASTRO SUITE 107
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-3650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8366
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00732-8366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-3650
-----------------------------------------------------
Fax | 787-844-3650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DBA
-----------------------------------------------------
Name | CARMEN PABON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-844-3650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 07F0111
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------