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General NPI Number Information
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NPI Number | 1992123574
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Entity Type | Organization
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Legal Business Name | PUEBLO INC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 1511 AVE PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-725-8112
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Fax | 787-725-8115
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Provider Business Mailing Address
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Address Line | PO BOX 1967
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City | CAROLINA
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State | PR
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Zip | 00984-1967
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Country | US
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Telephone | 787-757-3131
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Fax | 787-793-8144
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Authorized Official
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Title or Position | VP FINANCES
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Name | LUIS M MALDONADO-PENA
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Credential |
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Telephone | 787-757-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16F3186
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 16F3186
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 1835N1003X
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Taxonomy Name | Nutrition Support Pharmacist
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License Number | 16F3186
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 16F3186
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License Number State | PR
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Taxonomy #5
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 16F3186
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License Number State | PR
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Taxonomy #6
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 16F3186
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License Number State | PR
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Taxonomy #7
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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