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General NPI Number Information
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NPI Number | 1619044864
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Entity Type | Organization
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Legal Business Name | FARMACIA SAN JORGE INC.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | ST. ATOCHA 87C
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City | PONCE
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State | PR
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Zip | 00731
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Country | US
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Telephone | 787-840-5979
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Fax | 787-284-1167
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Provider Business Mailing Address
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Address Line | PO BOX 801245
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City | COTO LAUREL
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State | PR
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Zip | 00780-1245
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Country | US
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Telephone | 787-840-5979
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Fax | 787-284-1167
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LUZ E CRUZ-TORRES
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Credential | MANAGER
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Telephone | 787-840-5979
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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 | 08-F-2342
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License Number State | PR
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