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General NPI Number Information
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NPI Number | 1629505318
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Entity Type | Organization
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Legal Business Name | FARMACIA LA FE REFORMADA INC
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | THE NEW SHOPPING CENTER 421 MUNOZ RIVERA ESQUINA FERROCARRIL
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City | PONCE
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State | PUERTO RICO
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Zip | 00733
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Country | UM
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Telephone | 787-569-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 108 CALLE VICTORIA
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City | PONCE
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State | PUERTO RICO
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Zip | 00730
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Country | UM
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Telephone | 787-569-8700
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Fax | 787-842-4671
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAUL QUESADA
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Credential |
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Telephone | 787-479-7214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 19-F-3490
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License Number State | PR
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