MEDICARE: FAMMA GROUP CORPORATION

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	183500000X	Pharmacist	07F2285	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4024852	OTHER	PR	NCPDP

General Provider Information

NPI Number	:	1861539405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMMA GROUP CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 801091
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-1091
Country	:	US
Telephone Number	:	787-812-3789
Fax Number	:	787-812-3787

Provider Business Practice Location Address
First Line	:	2003 CARR 506 STE 101
Second Line	:	PLAZA SAN CRISTOBAL 2003
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2927
Country	:	US
Telephone Number	:	787-812-3789
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARMANDO MUNOZ
Credential	:
Telephone Number	:	787-812-3789

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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