# PANCHO BLU LLC DBA FARMACIAS ALIADAS GURABO

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

## Provider details

- **NPI number:** 1376885251
- **Authorized official:** EDWARD SAEZ (PRESIDENT)
- **Authorized official phone:** (787) 736-7100

## Contact information

- **Practice address:** RD 189 RALPH'S PLAZA, SUITE 6, GURABO, PR 00778
- **Practice address phone:** (787) 736-7100
- **Practice address fax:** (787) 736-0300
- **Mailing address:** STREET 4 \#150 URB EL PARQUE, SAN LORENZO, PR 00754
- **Mailing address phone:** (787) 736-7100
- **Mailing address fax:** (787) 736-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 15F3115 | PR | Yes |
| 3336S0011X | Specialty Pharmacy | 15F3115 | PR | — |

## Other

- **Enumeration date:** 03/19/2013
- **Last updated:** 03/19/2013