MEDICARE: CANOPHARM 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	333600000X	Pharmacy	07-F-1762	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4022315	OTHER	PR	NABP

General Provider Information

NPI Number	:	1750414470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANOPHARM INC.

Provider Business Mailing Address
First Line	:	AA-12 CALLE BAUHINIA STE 1
Second Line	:	URB. LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3440
Country	:	US
Telephone Number	:	787-876-3400
Fax Number	:	787-876-7631

Provider Business Practice Location Address
First Line	:	AA-12 CALLE BAUHINIA STE1
Second Line	:	URB. LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3440
Country	:	US
Telephone Number	:	787-876-3400
Fax Number	:	787-876-7631

Authorized Official
Title or Position	:	CHEIF PHARMACIST
Name	:	MRS. MAYRA E BORRERO
Credential	:	BD
Telephone Number	:	787-876-3400

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/07/2010

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Directions to “CANOPHARM INC. ” Practice Location

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