=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336537273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLMED PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2014
-----------------------------------------------------
Last Update Date | 12/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | STREET 54 INT. 3 COMMERCE PLAZA SUITE 101 GB-H
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00785-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-686-6464
-----------------------------------------------------
Fax | 787-686-6463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1918
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00785-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-686-6464
-----------------------------------------------------
Fax | 787-686-6463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ADALBERTO LLERA ROLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-686-6464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 16-F-3238
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------