=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255508206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA GABRIELA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2008
-----------------------------------------------------
Last Update Date | 05/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARRETERA 14 KM 11.1 BO COLLORES SECTOR CAYABO
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-260-2700
-----------------------------------------------------
Fax | 787-837-2100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 801214
-----------------------------------------------------
City | COTO LAUREL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00780-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-260-2700
-----------------------------------------------------
Fax | 787-837-2100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIZ ANN BANCHS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-391-3056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 17F2554
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------