MEDICARE: JUANA I FEBLES

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	004670	PR

General Provider Information

NPI Number	:	1861607699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA I FEBLES

Provider Business Mailing Address
First Line	:	2304 VEREDAS DEL LAUREL
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-3005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 CARR 506 STE 101
Second Line	:	PLAZA SAN CRISTOBAL 2003
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2929
Country	:	US
Telephone Number	:	787-848-8658
Fax Number	:	787-848-8658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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