=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720291891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAFAEL JAMIL ARBELO DECOS PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 01/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR #119 KM 0.3 BO PUENTE SECTOR ZARZA
-----------------------------------------------------
City | CAMUY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-898-5873
-----------------------------------------------------
Fax | 787-262-2883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 192 AVE DR SUSONI UNIT 1442
-----------------------------------------------------
City | HATILLO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00659-2227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-215-8687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5090
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------