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General NPI Number Information
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NPI Number | 1619417326
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Entity Type | Organization
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Legal Business Name | FARMACIA YANIZ L.L.C.
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | CARR 164 # KM142 BO PALMAREJO
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City | COROZAL
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State | PR
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Zip | 00783-2400
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Country | US
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Telephone | 787-693-0302
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Fax | 787-693-0302
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Provider Business Mailing Address
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Address Line | PO BOX 5034 BO MARICAO
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City | VEGA ALTA
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State | PR
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Zip | 00692-5034
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Country | US
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Telephone | 787-693-0302
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Fax | 787-693-0302
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Authorized Official
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Title or Position | MANAGER
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Name | MINALIS PANTOJAS
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Credential | PROPIETARY
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Telephone | 787-693-0302
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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 | 19-F-3469
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License Number State | PR
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