1295857050 NPI number — FARMACIA LA SAGRADA FAMILIA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295857050 NPI number — FARMACIA LA SAGRADA FAMILIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA LA SAGRADA FAMILIA, INC.
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:
1295857050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COROZAL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00783-0102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-869-5591
Provider Business Mailing Address Fax Number:
787-859-2557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NARANJITO SHOPPING VILLAGE CARR. 152, KM 12.4
Provider Second Line Business Practice Location Address:
BO CEDRO ARRIBA
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-5591
Provider Business Practice Location Address Fax Number:
787-859-2557
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
GERENTE DE FARMACIA
Authorized Official Telephone Number:
787-869-5591

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  DF025619 , 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)





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