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General NPI Number Information
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NPI Number | 1518011758
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Entity Type | Organization
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Legal Business Name | SUPER FARMACIA ARZUAGA INC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | CAROLINA SHOPPING COURT 1 LOCAL 103-B CARR#3 ESQ ROBERTO CLEMENTE
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-767-2626
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Fax | 787-767-2626
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Provider Business Mailing Address
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Address Line | CAROLINA SHOPPING COURT LOCAL 103-B CARR#3 ESQ ROBERTO CLEMENTE
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-767-2626
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Fax | 787-767-2626
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDGARDO HERNANDEZ
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Credential | CEO
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Telephone | 787-767-2626
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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 | 09-F-0307
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 20F3554
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License Number State | PR
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