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Organization
OWN BUSSINESS
Active
Organization
OWN BUSSINESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA LEE GONZALEZ (PHARMACY TECHNICIAN)
(787) 365-8662
Entity
Organization
Contact information
Practice address
1933 CALLE GUAYABO, LOS CAOBOS, PONCE, PR 00716
(787) 365-8662
Mailing address
1933 CALLE GUAYABO, LOS CAOBOS, PONCE, PR 00716
(787) 365-8662
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132035
REGISTER AND CERTIFICATION NUMBER (ACTIVE )
PR
Enumeration date
04/29/2014
Last updated
04/29/2014
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