Organization
FARMACIA LAGO VISTA INC CALLE CAYMAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICMARIS GONZALEZ (VICE-PRESIDENT)
(787) 784-4585
Entity
Organization
Contact information
Practice address
AVE BLVD 3386 LEVITTOWN, PASEO CARMEN 3385-86, TOA BAJA, PR 00949
(787) 784-4585
(787) 795-1465
Mailing address
PO BOX 51063, TOA BAJA, PR 00950-1063
(787) 784-4585
(787) 795-1465
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19F0278
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2084147
PK
—
Enumeration date
01/30/2007
Last updated
05/04/2018
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