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General NPI Number Information
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NPI Number | 1366593329
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Entity Type | Organization
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Legal Business Name | TOA ALTA PHARMACY, INC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 253 CALLE MENDEZ VIGO
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City | DORADO
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State | PR
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Zip | 00646-4905
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Country | US
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Telephone | 787-870-1434
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Fax | 787-870-0169
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Provider Business Mailing Address
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Address Line | 253 CALLE MENDEZ VIGO
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City | DORADO
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State | PR
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Zip | 00646-4905
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Country | US
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Telephone | 787-870-1434
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Fax | 787-870-0169
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA S MARRERO
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Credential |
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Telephone | 787-870-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 09F0189
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License Number State | PR
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