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General NPI Number Information
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NPI Number | 1851575112
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Entity Type | Organization
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Legal Business Name | FARMACIA DEJIREH CORP
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | CARRETERA 3 URB BUZO 443
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-852-2828
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Fax | 787-852-4622
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | HUMACAO
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State | PR
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Zip | 00792-0548
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Country | US
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Telephone | 787-852-2828
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Fax | 787-852-4622
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACQUELINE SERRANO
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Credential | RPH
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Telephone | 787-559-1137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 15F2572
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License Number State | PR
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