=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568835395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIFARMA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2015
-----------------------------------------------------
Last Update Date | 01/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1232 AVE MUNOZ RIVERA REPTO UNIVERSITARIO
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-0639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-841-4539
-----------------------------------------------------
Fax | 787-841-2659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1232 AVE MUNOZ RIVERA REPTO UNIVERSITARIO
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-0639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-841-4539
-----------------------------------------------------
Fax | 787-841-2659
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | YIOVANNA ALMODOVAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-841-4539
-----------------------------------------------------
=====================================================
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 | 17-F-3334
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------