Basic Information
| Provider Information | |||||||||
| NPI: | 1952434912 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FARMACIA SAN JORGE CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6308 | ||||||||
| Address2: | LOIZA STATION | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009146308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877271000 | ||||||||
| FaxNumber: | 7877270550 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 CALLE CONVENTO | ||||||||
| Address2: | |||||||||
| City: | SANTURCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009123207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877271000 | ||||||||
| FaxNumber: | 7877270550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | DOMINGO | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP SENIORS OPERATION PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877271000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 08F2464 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4021313 | 01 | PR | NABP | OTHER |