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General NPI Number Information
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NPI Number | 1952454423
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Entity Type | Organization
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Legal Business Name | SUPER FARMAACIA IDEAL
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CENTRO COMERCIAL EL COMANDANTE AVE. 65 INF. ESQ. SAN MARCOS
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-752-9120
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Fax | 787-776-1148
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Provider Business Mailing Address
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Address Line | PO BOX 29003 65 INFANTERIA STATION
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City | SAN JUAN
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State | PR
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Zip | 00929-0003
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Country | US
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Telephone | 787-752-9120
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Fax | 787-776-1148
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. YARIMAR A GUERRERO
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Credential |
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Telephone | 787-752-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 07-F-2123
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License Number State | PR
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