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General NPI Number Information
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NPI Number | 1376093401
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Entity Type | Organization
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Legal Business Name | HIS PHARMACY LLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | EDIFICIO PUGNADO CARR. 137 KM 7.2 LOCAL 2 BO. PUGNADO
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City | VEGA BAJA
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State | PR
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Zip | 00693-0000
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Country | US
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Telephone | 787-965-7999
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Fax | 787-965-7998
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Provider Business Mailing Address
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Address Line | PASEO LOS CORALES II 766 CALLE MAR DEL NORTE
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City | DORADO
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State | PR
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Zip | 00646-0000
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Country | US
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Telephone | 939-717-5670
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CORALYS MORALES
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Credential |
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Telephone | 939-717-5670
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 18-F-3403
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License Number State | PR
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