MEDICARE: FARMACIA GLORIVEE I LLC

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

General Provider Information

NPI Number	:	1487056362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA GLORIVEE I LLC

Provider Business Mailing Address
First Line	:	59 CALLE DAGUEY
Second Line	:
City	:	ANASCO
State	:	PR
Zip	:	00610-2602
Country	:	US
Telephone Number	:	787-229-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 CALLE DAGUEY
Second Line	:
City	:	ANASCO
State	:	PR
Zip	:	00610-2602
Country	:	US
Telephone Number	:	787-229-1313
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. GLORIVEE CORTES
Credential	:	RPH
Telephone Number	:	787-229-1313

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	07/17/2020

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