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General NPI Number Information
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NPI Number | 1639236946
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Entity Type | Organization
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Legal Business Name | FARMACIA MEDINA 5 INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | BO SABANA LLANA 486 CALLE DE DIEGO
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City | SAN JUAN
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State | PR
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Zip | 00923-3141
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Country | US
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Telephone | 787-763-0255
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Fax | 787-763-0360
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Provider Business Mailing Address
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Address Line | BO SABANA LLANA 486 CALLE DE DIEGO
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City | SAN JUAN
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State | PR
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Zip | 00923-3141
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Country | US
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Telephone | 787-763-0255
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Fax | 787-763-0360
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL CORDERO
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Credential | RPH
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Telephone | 787-763-0255
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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 | 18-F-3048
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License Number State | PR
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