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General NPI Number Information
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NPI Number | 1306192828
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Entity Type | Organization
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Legal Business Name | PRO HEALTH PHARMACY, INC.
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | #312 32ND ST URBANIZACION VILLA NEVAREZ
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City | SAN JUAN
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State | PR
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Zip | 00927
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Country | US
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Telephone | 787-402-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 312 32ND ST VILLA NEVAREZ
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City | SAN JUAN
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State | PR
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Zip | 00927
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Country | US
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Telephone | 787-402-1736
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMELIA NIEVES
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Credential | BSPH
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Telephone | 787-402-1736
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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 | 14F3042
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License Number State | PR
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