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General NPI Number Information
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NPI Number | 1194841932
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Entity Type | Organization
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Legal Business Name | VIDIMA CORPORATION
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 39 PASEO GAUTIER BENITEZ
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-743-5935
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Fax | 787-258-6155
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Provider Business Mailing Address
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Address Line | 39 PASEO GAUTIER BENITEZ
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-743-5935
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Fax | 787-258-6155
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Authorized Official
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Title or Position | PHARMACIST
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Name | MARITSA IVETTE DIAZ
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Credential | CPH
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Telephone | 787-743-5935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 09F1329
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License Number State | PR
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