Organization
PHARMAEXTRA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIOT PACHECO BEAUCHAMP MBA (CEO)
(787) 738-5343
Entity
Organization
Contact information
Practice address
MUNOZ RIVERA 56 SOUTH, CAYEY, PR 00736
(787) 738-5343
(787) 263-2883
Mailing address
PO BOX 372830, CAYEY, PR 00737-2830
(787) 738-5343
(787) 263-2883
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
18F2690
PR
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2086486
PK
—
Enumeration date
08/10/2006
Last updated
01/30/2018
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