=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376904490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2016
-----------------------------------------------------
Last Update Date | 01/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 115 KM 20.5
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-868-0555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB. MONTEMAR D 56
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-868-0555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MRS
-----------------------------------------------------
Name | BETSY CABAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-868-0555
-----------------------------------------------------
=====================================================
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 | 18F3369
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------