MEDICARE: PRO FPS 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	20-F-3533	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2175725	OTHER		PK

General Provider Information

NPI Number	:	1952819153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO FPS GROUP CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1411
Second Line	:
City	:	LAJAS
State	:	PR
Zip	:	00667-1411
Country	:	US
Telephone Number	:	787-821-1267
Fax Number	:	787-821-1474

Provider Business Practice Location Address
First Line	:	CARR 116 RAMAL 1116
Second Line	:	KM 27.7
City	:	GUANICA
State	:	PR
Zip	:	00653-2105
Country	:	US
Telephone Number	:	787-821-1267
Fax Number	:	787-821-1474

Authorized Official
Title or Position	:	OWNER
Name	:	MILTON LUGO
Credential	:
Telephone Number	:	787-207-8586

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	08/08/2022

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Directions to “PRO FPS GROUP CORPORATION ” Practice Location

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