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General NPI Number Information
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NPI Number | 1548550783
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Entity Type | Organization
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Legal Business Name | FRAVAMAR CORP
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | CARRETERA #1 KM 49.5 BO BEATRIZ
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City | CIDRA
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State | PR
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Zip | 00739
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Country | US
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Telephone | 787-263-2939
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Fax | 787-743-5706
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Provider Business Mailing Address
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Address Line | PO BOX 6838
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City | CAGUAS
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State | PR
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Zip | 00726-6838
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | JOSE ESTRADA
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Credential |
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Telephone | 787-263-2939
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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 | 13F2915
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License Number State | PR
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