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General NPI Number Information
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NPI Number | 1962861153
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Entity Type | Organization
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Legal Business Name | LOS PAISANOS
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 200 CALLE CUPEY GDNS STE 1E
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City | CUPEY
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State | PR
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Zip | 00926-7341
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Country | US
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Telephone | 787-761-1212
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Fax | 787-761-1255
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Provider Business Mailing Address
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Address Line | 200 CALLE CUPEY GDNS STE 1E
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City | CUPEY
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State | PR
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Zip | 00926-7341
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Country | US
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Telephone | 787-761-1212
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Fax | 787-761-1255
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | TARIK HAMID
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Credential |
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Telephone | 787-761-1212
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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 | 4756547
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License Number State | PR
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