MEDICARE: FAMILY PHARMACY CONCEPTS

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	3336C0003X	Community/Retail Pharmacy	09-F-1663	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4021680	OTHER	PR	NABP

General Provider Information

NPI Number	:	1144205386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHARMACY CONCEPTS

Provider Business Mailing Address
First Line	:	PO BOX 427
Second Line	:	PMB 129
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-0427
Country	:	US
Telephone Number	:	787-826-2545
Fax Number	:	787-826-4022

Provider Business Practice Location Address
First Line	:	67 CALLE 65 INFANTERIA
Second Line	:
City	:	ANASCO
State	:	PR
Zip	:	00610-2909
Country	:	US
Telephone Number	:	787-826-2545
Fax Number	:	787-826-4022

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANCISCO A RIVERA
Credential	:
Telephone Number	:	787-546-4172

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	05/27/2008

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