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NPI Code Detail

MEDICARE: FARMACIA SAN RAFAEL, INC

MEDICARE: FARMACIA SAN RAFAEL, 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
1332B00000XDurable Medical Equipment & Medical SuppliesCFOM0538VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115-F-2298OTHERPRPHARMACY LICENSE
2DF-02802-7OTHERPRHEALTH DEPARTMENT LICENSE

General Provider Information

NPI Number : 1699710673
Entity Type Code : Organization
Provider Name (Legal Business Name) : FARMACIA SAN RAFAEL, INC
Provider Business Mailing Address
First Line : 851 CALLE LAFAYETTE
Second Line : PDA 20
City : SAN JUAN
State : PR
Zip : 00909-2627
Country : US
Telephone Number : 787-722-4803
Fax Number : 787-721-3399
Provider Business Practice Location Address
First Line : 851 CALLE LAFAYETTE
Second Line : PDA 20
City : SAN JUAN
State : PR
Zip : 00909-2627
Country : US
Telephone Number : 787-722-4803
Fax Number : 787-721-3399
Authorized Official
Title or Position : DEPARTMENT ADMINISTRATION/OWNER
Name : MISS LUZ V DIAZ REYES
Credential : CFOM, AUX PHARMACY
Telephone Number : 17877224803
Provider Enumeration Date : 06/16/2006
Last Update Date : 05/21/2014

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1851835615 — RAFAEL DIAZ REYES PH.T.
Practice Location Address:
851 CALLE LAFAYETTE , URB. HIPODROMO
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00909-2627
Practice Phone: 787-724-3333
Practice Fax: 787-721-4165

Directions to “FARMACIA SAN RAFAEL, INC ” Practice Location

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