MEDICARE: QUALITY HEALTH SERVICE OF PUERTO RICO 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	3336C0003X	Community/Retail Pharmacy	5174	PR

General Provider Information

NPI Number	:	1750596862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY HEALTH SERVICE OF PUERTO RICO INC

Provider Business Mailing Address
First Line	:	PO BOX 800501
Second Line	:	COTO LAUREL
City	:	PONCE
State	:	PR
Zip	:	00780-0501
Country	:	US
Telephone Number	:	787-848-2100
Fax Number	:	787-848-0022

Provider Business Practice Location Address
First Line	:	CARRETERA PR 506
Second Line	:	COTO LAUREL
City	:	PONCE
State	:	PR
Zip	:	00780-0501
Country	:	US
Telephone Number	:	787-848-2100
Fax Number	:	787-848-0022

Authorized Official
Title or Position	:	DIRECTORA SERVICIOS FARMACEUTICOS
Name	:	DR. HAROLINE RIVERA
Credential	:	PHARMD
Telephone Number	:	787-848-2100

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/31/2008

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