MEDICARE: EL BOTINQUIN DE CUPEY 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	10F2633	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4026476	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1922258854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL BOTINQUIN DE CUPEY INC

Provider Business Mailing Address
First Line	:	PO BOX 8729
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB PURPLE TREE
Second Line	:	1749 CARR 844
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4446
Country	:	US
Telephone Number	:	787-755-1600
Fax Number	:	787-755-1668

Authorized Official
Title or Position	:	RPH
Name	:	LYDIA NAVAREZ
Credential	:
Telephone Number	:	787-982-2323

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	12/23/2010

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