=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871732800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARMEN I. RUBIO SOTO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2009
-----------------------------------------------------
Last Update Date | 03/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 CALLE PRINCIPAL BOX 415
-----------------------------------------------------
City | MOROVIS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00687-3014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-862-5252
-----------------------------------------------------
Fax | 787-862-5599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 CALLE PRINCIPAL BOX 415
-----------------------------------------------------
City | MOROVIS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00687-3014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-862-5252
-----------------------------------------------------
Fax | 787-862-5599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | MRS. CARMEN I RUBIO
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 787-862-5252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 3430
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------