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General NPI Number Information
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NPI Number | 1194057950
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Entity Type | Organization
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Legal Business Name | SAMS CLUB # 6270
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | CARR.#2 KM 84.2 ESQUINA CARRIZALES
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City | HATILLO
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State | PR
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Zip | 00659
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Country | US
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Telephone | 787-544-7279
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Fax | 787-820-5409
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Provider Business Mailing Address
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Address Line | CARR.#2 KM 84.2 ESQUINA CARRIZALES
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City | HATILLO
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State | PR
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Zip | 00659
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Country | US
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Telephone | 787-544-7279
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Fax | 787-820-5409
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Authorized Official
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Title or Position | RETAIL STRATEGIC BUSINESS DIRECTOR
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Name | MR. RENE PABON
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Credential |
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Telephone | 787-653-8094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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