MEDICARE: SAN ARCANGEL PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	4015207	PR
2	183500000X	Pharmacist	07-F-0258	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07-F-0258	OTHER	PR	STATE LICENCE P.R.

General Provider Information

NPI Number	:	1114027141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ARCANGEL PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 863
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-0863
Country	:	US
Telephone Number	:	787-744-3400
Fax Number	:	787-258-3400

Provider Business Practice Location Address
First Line	:	2 CALLE MUNOZ RIVERA
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2603
Country	:	US
Telephone Number	:	787-744-3400
Fax Number	:	787-258-3400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LILLIAN QUINTERO
Credential	:	R. PH.
Telephone Number	:	787-744-3400

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	05/30/2008

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Directions to “SAN ARCANGEL PHARMACY ” Practice Location

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