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General NPI Number Information
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NPI Number | 1720185655
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Entity Type | Organization
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Legal Business Name | FARMACIA EL DIVINO NINO LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 06/29/2025
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Provider Practice Location Address
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Address Line | CARR 110 KM 10.5 835 CONCEPCION VERA
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-818-4839
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Fax | 787-877-8129
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Provider Business Mailing Address
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Address Line | 835 CALLE CONCEPCION VERA
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City | MOCA
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State | PR
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Zip | 00676-5016
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Country | US
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Telephone | 787-818-4839
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Fax | 787-877-8129
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | XOCHITL RIVERA
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Credential | RPH
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Telephone | 787-818-4839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 17-F-2289
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License Number State | PR
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