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General NPI Number Information
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NPI Number | 1730122110
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Entity Type | Organization
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Legal Business Name | SUPERTIENDA FAMILIAR INC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | SAN FRANCISCO STE 255
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City | SAN JUAN
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State | PR
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Zip | 00901-1724
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Country | US
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Telephone | 787-722-0335
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Fax | 787-725-8292
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Provider Business Mailing Address
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Address Line | PO BOX 79514
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City | CAROLINA
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State | PR
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Zip | 00984-9514
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Country | US
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Telephone | 787-722-0335
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Fax | 787-725-8292
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUAN FERNANDEZ FERNANDEZ
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Credential |
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Telephone | 787-508-9306
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 17-F-3302
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License Number State | PR
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