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General NPI Number Information
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NPI Number | 1770117509
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Entity Type | Organization
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Legal Business Name | BIENESTAR PHARMACY GROUP
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | CARR 718 KM 1.1 BO PASTO, SECT. LA PLAYITA
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City | AIBONITO
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State | PR
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Zip | 00705
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Country | US
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Telephone | 787-303-0799
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Fax | 787-333-6188
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Provider Business Mailing Address
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Address Line | EDIFICIO CENTRAL CALLE BALDORIOTY 165 NORTE BUZON #2
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City | AIBONITO
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State | PR
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Zip | 00705
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Country | US
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Telephone | 939-545-0524
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Fax | 939-545-0700
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. JOSE R DE TERREFORTE-DIAZ
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Credential | MD, MPH
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Telephone | 939-545-0522
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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 |
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License Number State |
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