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General NPI Number Information
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NPI Number | 1871872671
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Entity Type | Organization
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Legal Business Name | MI FARMACIA SAN ISIDRO
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 2 CALLE GUAYACAN
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City | CANOVANAS
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State | PR
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Zip | 00729-9815
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Country | US
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Telephone | 787-256-0069
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Fax | 787-256-0069
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Provider Business Mailing Address
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Address Line | 2 CALLE GUAYACAN
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City | CANOVANAS
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State | PR
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Zip | 00729-9815
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Country | US
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Telephone | 787-256-0069
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Fax | 787-256-0069
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Authorized Official
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Title or Position | PHARMACEUTICAL
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Name | MRS. MARITZA JIMENEZ
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Credential | LCDA
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Telephone | 787-256-0069
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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 | 5089
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License Number State | PR
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