=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932185824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA EL TUQUE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2005
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 553 CALLE RAMOS ANTONINI EL TUQUE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00728-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-2805
-----------------------------------------------------
Fax | 787-841-5551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 553 CALLE RAMOS ANTONINI PARC EL TUQUE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00728-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-2805
-----------------------------------------------------
Fax | 787-841-5551
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WALDEMAR J NIEVES
-----------------------------------------------------
Credential | PHARM D.
-----------------------------------------------------
Telephone | 787-844-2805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 06-F-2252
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------