=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619002268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRIZIAS DRUG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR.#2 KM 98.7 BO.COCOS
-----------------------------------------------------
City | QUEBRADILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-895-5702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE LINARES #205
-----------------------------------------------------
City | QUEBRADILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-895-5702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FARMACEUTICO
-----------------------------------------------------
Name | MARITZA LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-895-5702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 07F1498
-----------------------------------------------------
License Number State |
-----------------------------------------------------