MEDICARE: FARMACIA DEL CONDADO, INC CSP

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	333600000X	Pharmacy	1184760001	PR

General Provider Information

NPI Number	:	1528050192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA DEL CONDADO, INC CSP

Provider Business Mailing Address
First Line	:	H18 CALLE JOSE VILLARES
Second Line	:	CONDADO
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	787-743-0001
Fax Number	:	787-743-0001

Provider Business Practice Location Address
First Line	:	H18 CALLE JOSE VILLARES
Second Line	:	CONDADO
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	787-743-0001
Fax Number	:	787-743-0001

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GLORIVETTE SENERIZ
Credential	:
Telephone Number	:	787-743-0001

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/22/2020

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