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General NPI Number Information
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NPI Number | 1679565048
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Entity Type | Organization
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Legal Business Name | FARMACIA MARISEL #1
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | STREET NOYA & HERNANDEZ #2
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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 | 787-852-4535
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Fax | 787-852-4565
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Provider Business Mailing Address
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Address Line | PO BOX 8567
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City | HUMACAO
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State | PR
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Zip | 00792-8567
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Country | US
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Telephone | 787-852-4535
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Fax | 787-852-4565
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARISEL MENCHACA
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Credential | PHARMACIST
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Telephone | 787-852-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 07-F-1209
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 07-F-1209
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License Number State | PR
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