MEDICARE: FARMACIA DEL PUEBLO I-JUNCOS

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	251S00000X	Community/Behavioral Health Agency	003523	PR

General Provider Information

NPI Number	:	1891902094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA DEL PUEBLO I-JUNCOS

Provider Business Mailing Address
First Line	:	PARCELAS LAS CUATROCIENTAS
Second Line	:	HC-03 BOX 8210
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-736-3143
Fax Number	:	787-734-6767

Provider Business Practice Location Address
First Line	:	CALLE #10 CASA 102
Second Line	:	PARCELAS DE VALENCIANO BO. VALENCIANO ABAJO
City	:	JUNCOS
State	:	PR
Zip	:	00777-0000
Country	:	US
Telephone Number	:	787-736-3143
Fax Number	:	787-734-6767

Authorized Official
Title or Position	:	TECNICO DE FARMACIA
Name	:	MRS. RIVERA CASTRO BRENDA LIZ
Credential	:	FARMACEUTICO
Telephone Number	:	787-734-3081

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/18/2008

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