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General NPI Number Information
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NPI Number | 1962887638
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Entity Type | Organization
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Legal Business Name | COSSMA
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 50 CALLE ULISES MARTINEZ N
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City | HUMACAO
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State | PR
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Zip | 00791-3636
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Country | US
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Telephone | 787-739-8182
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Fax | 787-285-1232
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | HUMACAO
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State | PUERTO RICO
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Zip | 00792
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Country | UM
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Telephone | 787-559-7917
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Fax |
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Authorized Official
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Title or Position | TECNICA DE FARMACIA
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Name | LESLYBETH LEBRON RODRIGUEZ
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Credential |
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Telephone | 787-739-8182
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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 | 9515
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License Number State | PR
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