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General NPI Number Information
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NPI Number | 1215250238
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Entity Type | Organization
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Legal Business Name | MMR SUPERMARKET INC
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | CARR 183, KM 1 SAN LORENZO SHOPPING CENTER
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City | SAN LORENZO
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State | PR
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Zip | 00754
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Country | US
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Telephone | 787-715-1770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1657 FARMACIA DON MODE
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977-1657
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ATTORNEY
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Name | IGNACIO VIDAL
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Credential |
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Telephone | 787-751-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 16F2799
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License Number State | PR
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