=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912371576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUQUILLO PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2015
-----------------------------------------------------
Last Update Date | 02/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 CALLE FERNANDEZ GARCIA LOCAL 1 LUQUILLO PLAZA
-----------------------------------------------------
City | LUQUILLO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00773-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-355-7100
-----------------------------------------------------
Fax | 787-355-7052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AA12 CALLE BAUHINIA STE 1
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729-3551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-355-7100
-----------------------------------------------------
Fax | 787-355-7052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RASMI RASHID
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-355-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 17F3318
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------