=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497388938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA LA NUEVA MONSERRATE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2020
-----------------------------------------------------
Last Update Date | 02/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HORMIGUEVOS TWIN PLAZA CARR, 3344 KM 0.7
-----------------------------------------------------
City | HORMIGUEVOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-849-2997
-----------------------------------------------------
Fax | 787-255-9777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC-02 BOX 9285
-----------------------------------------------------
City | HORMINGUEVAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-849-2997
-----------------------------------------------------
Fax | 787-255-9777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LINNETTE TOLEDO VEGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-849-2997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------