# MARIO DE JESUS CRUZ INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Farmacia La Milagrosa
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801825658
- **Authorized official:** MARIO DE JESUS CRUZ PHARMACIST (PRESIDENT)
- **Authorized official phone:** (787) 891-1060

## Contact information

- **Practice address:** AVE SAN CARLOS ESQ COSMERCIO \#1, AGUADILLA, PR 00605
- **Practice address phone:** (787) 891-1060
- **Practice address fax:** (787) 882-5075
- **Mailing address:** PO BOX 907, AGUADILLA, PR 00605-0907
- **Mailing address phone:** (787) 891-1060
- **Mailing address fax:** (787) 882-5075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 07F0214 | PR | Yes |

## Other

- **Enumeration date:** 07/02/2006
- **Last updated:** 08/22/2020