1124242144 NPI number — WL PHARMACY CORP

Table of content: (NPI 1124242144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124242144 NPI number — WL PHARMACY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WL PHARMACY CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124242144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB RASHOLISA # 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-896-2080
Provider Business Mailing Address Fax Number:
787-896-6615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 URB RAHOLISA GDNS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-2080
Provider Business Practice Location Address Fax Number:
787-896-6615
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORO PEREZ
Authorized Official First Name:
JULIO
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-896-2080

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  6235120001 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 07F2309 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)