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General NPI Number Information
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NPI Number | 1972644060
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Entity Type | Organization
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Legal Business Name | FARMACIA PONTEZUELA 24 LLC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | CALLE AUTONOMIA STE 72
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City | CANOVANAS
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State | PR
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Zip | 00729-3249
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Country | US
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Telephone | 787-876-2174
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29619
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City | SAN JUAN
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State | PR
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Zip | 00929-0619
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Country | US
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Telephone | 787-876-2174
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE SANCHEZ
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Credential |
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Telephone | 787-649-7450
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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 | 17-F-3332
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License Number State | PR
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