MEDICARE: FARMACIA JARDINES DEL CARIBE

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	07-F-1042	PR

General Provider Information

NPI Number	:	1376620872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA JARDINES DEL CARIBE

Provider Business Mailing Address
First Line	:	111 CALLE 17
Second Line	:	URB. JARDINES DEL CARIBE
City	:	PONCE
State	:	PR
Zip	:	00728-4448
Country	:	US
Telephone Number	:	787-843-8023
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CALLE 17
Second Line	:	URB. JARDINES DEL CARIBE
City	:	PONCE
State	:	PR
Zip	:	00728-4448
Country	:	US
Telephone Number	:	787-843-8023
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GUILLERMO ECHEVARRIA
Credential	:
Telephone Number	:	787-843-8023

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/18/2008

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