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General NPI Number Information
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NPI Number | 1932196532
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Entity Type | Organization
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Legal Business Name | FARMACIA MODELO
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4 CALLE MUNOZ RIVERA FARMACIA MODELO
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City | CAGUAS
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State | PR
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Zip | 00725-2685
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Country | US
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Telephone | 787-743-3975
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Fax | 787-746-6869
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Provider Business Mailing Address
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Address Line | 4 CALLE MUNOZ RIVERA FARMACIA MODELO
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City | CAGUAS
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State | PR
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Zip | 00725-2685
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Country | US
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Telephone | 787-743-3975
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Fax | 787-746-6869
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Authorized Official
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Title or Position | OWNER
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Name | JOSE A SANTIAGO
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Credential |
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Telephone | 787-743-3975
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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 | 07-F-2050
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License Number State | PR
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