MEDICARE: DAMAR OF PUERTO RICO SERVICES, INC.

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	3336C0002X	Clinic Pharmacy
2	3336C0003X	Community/Retail Pharmacy	17-F-3157	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2086936	OTHER		PK

General Provider Information

NPI Number	:	1467583328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMAR OF PUERTO RICO SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 25130
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-5130
Country	:	US
Telephone Number	:	787-722-4600
Fax Number	:	787-723-4068

Provider Business Practice Location Address
First Line	:	CALLE CERRA 900 FINAL
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00907-5104
Country	:	US
Telephone Number	:	787-722-4600
Fax Number	:	787-723-4068

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	ALLAN CAO
Credential	:	PHARMACIST
Telephone Number	:	786-547-3240

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	09/21/2015

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