=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851442750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA KIARA CRL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 149 RAMAL 1 BO. CAPITANEJO SECTOR PASTILLO
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-260-0077
-----------------------------------------------------
Fax | 787-837-2299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1722 CALLE LLANURA VALLE ALTO
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-260-0077
-----------------------------------------------------
Fax | 787-837-2299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. JUAN CARLOS SEGARRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-260-0077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------