=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205045689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA CEDROS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 09/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 185 KM 127 BO CEDROS
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-768-0500
-----------------------------------------------------
Fax | 787-768-0500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 11824
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-768-0500
-----------------------------------------------------
Fax | 787-768-0500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DUENA
-----------------------------------------------------
Name | MRS. AIDA LIZ FERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-768-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 09 F 1401
-----------------------------------------------------
License Number State |
-----------------------------------------------------