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General NPI Number Information
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NPI Number | 1639437155
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Entity Type | Organization
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Legal Business Name | SHADDAI PHARMACY INC.
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 28A BLOQUE BB1 LOCAL 2 VILLA UNIVERSITARIA
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-852-7676
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Fax | 787-850-7053
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Provider Business Mailing Address
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Address Line | 14 CALLE OPALO MANSIONES DEL CARIBE
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City | HUMACAO
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State | PR
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Zip | 00791-5200
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Country | US
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Telephone | 787-852-7676
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Fax | 787-850-7053
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH RIVERA RIOS
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Credential | PHARMACIST
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Telephone | 787-691-2518
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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 | 14-F-3019
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License Number State | PR
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