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General NPI Number Information
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NPI Number | 1902247349
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Entity Type | Organization
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Legal Business Name | PRESTAMO PHARMACY
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | CARR. 867 KM 5.4 #204
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-644-8663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 682
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City | TOA BAJA
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State | PR
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Zip | 00951-0682
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Country | US
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Telephone | 787-644-8663
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Fax |
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Authorized Official
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Title or Position | PHARMACY
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Name | JOSEFINA PRESTAMO
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Credential |
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Telephone | 787-644-8663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 15-F-3142
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License Number State |
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