=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851428502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA SANTA CRUZ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 CALLE SANTA CRUZ STE 101
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-798-4646
-----------------------------------------------------
Fax | 787-288-8111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 101
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00960-0101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-798-4646
-----------------------------------------------------
Fax | 787-288-8111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NORBERTO ROLON
-----------------------------------------------------
Credential | PH
-----------------------------------------------------
Telephone | 787-798-4646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2037
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------