# FARMACIA SHALOM INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205168853
- **Authorized official:** MISS MARIA DE LOS ANGELES PAGAN LUGO (OWNER)
- **Authorized official phone:** (787) 895-0914

## Contact information

- **Practice address:** CARR 2 KM 101 6 MARGINAL DEL PARQUE, TERRANOVA, QUEBRADILLAS, PR 00678
- **Practice address phone:** (787) 895-0914
- **Practice address fax:** (787) 895-4999
- **Mailing address:** PO BOX 903, QUEBRADILLAS, PR 00678-0903
- **Mailing address phone:** (787) 895-0914
- **Mailing address fax:** (787) 895-4999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 11-F-2777 | PR | Yes |

## Other

- **Enumeration date:** 02/08/2010
- **Last updated:** 02/08/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11-F-2777 | PHARMACY SERVICES | PR |