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General NPI Number Information
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NPI Number | 1689752941
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Entity Type | Organization
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Legal Business Name | SUPER FARMACIA TRIPLE R, INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 4020 CARR 2 SUITE 28, PLAZA JARDINES
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City | VEGA BAJA
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State | PR
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Zip | 00693-6141
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Country | US
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Telephone | 787-855-6033
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Fax | 787-855-6033
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Provider Business Mailing Address
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Address Line | 4020, CARR #2 SUITE 28, PLAZA JARDINES
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-855-6033
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Fax | 787-855-6033
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. LUZ R ROLON
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Credential | PHARMACIST
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Telephone | 787-855-6033
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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 | 11-F-1206
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License Number State | PR
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