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General NPI Number Information
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NPI Number | 1417371303
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Entity Type | Organization
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Legal Business Name | FARMACIA SAN RAFAEL SANTURCE, INC.
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 851 CALLE LAFAYETTE
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City | SAN JUAN
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State | PR
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Zip | 00909-2627
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Country | US
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Telephone | 787-724-3307
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Fax | 787-919-7058
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Provider Business Mailing Address
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Address Line | PO BOX 19791
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City | SAN JUAN
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State | PR
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Zip | 00910-1791
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Country | US
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Telephone | 787-724-3307
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Fax | 787-919-7058
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFAEL DIAZ REYES
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Credential |
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Telephone | 787-724-3307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 17-F-2298
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License Number State | PR
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