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General NPI Number Information
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NPI Number | 1225394109
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Entity Type | Organization
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Legal Business Name | LIFE PHARMACY CORP.
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | CARR. 110 KM 11.2 BO. PUEBLO
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-818-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 815 CALLE CONCEPCION VERA
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-818-5433
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/PRESIDENT
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Name | MRS. NOEMI CORTES
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Credential | B.PHARM
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Telephone | 787-818-5433
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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 | 4877
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 19-F-3497
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License Number State | PR
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