=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215064845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA DON BOSCO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 01/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE 12 SE 1114 CAPARRA TERRACE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-782-8017
-----------------------------------------------------
Fax | 787-783-5689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5012
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00984-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-782-8017
-----------------------------------------------------
Fax | 787-783-5689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MRS. CAROLL CORREA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-782-8017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 07F2180
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------