Provider Demographics
NPI:1225367162
Name:SANTA CRUZ PHARMA CARE, LLC
Entity Type:Organization
Organization Name:SANTA CRUZ PHARMA CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:787-798-4646
Mailing Address - Street 1:EDIFICIO MEDICO SANTA CRUZ, SUITE # 101
Mailing Address - Street 2:CALLE SANTA CRUZ # 73
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6911
Mailing Address - Country:US
Mailing Address - Phone:787-798-4646
Mailing Address - Fax:787-288-8111
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:SANTA CRUZ BLDG, SUITE # 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-798-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy