=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912061904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GC PHARMACY GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 07/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE COLON # 252 BO. PUEBLO
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602-3166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-868-8544
-----------------------------------------------------
Fax | 787-868-8544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE COLON # 252
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602-3166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-868-8544
-----------------------------------------------------
Fax | 787-868-8544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GLORIVEE CORTES
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 787-382-5110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 19-F-3416
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------