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General NPI Number Information
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NPI Number | 1982739587
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Entity Type | Organization
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Legal Business Name | DIVAMAR INC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | CALLE LA PINTA BF-15 AVE. BAIROA
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City | BAIROA CAGUAS
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State | PR
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Zip | 00725-1472
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Country | US
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Telephone | 787-744-9164
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Fax | 787-744-3988
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Provider Business Mailing Address
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Address Line | CALLE LA PINTA BF-15 AVE. BAIROA
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City | BAIROA CAGUAS
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State | PR
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Zip | 00725-1472
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Country | US
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Telephone | 787-744-9164
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Fax | 787-744-3988
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Authorized Official
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Title or Position | PRESIDENT
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Name | MODESTO SANTIAGO
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Credential |
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Telephone | 787-744-9164
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 18-F-2423
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License Number State | PR
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