1467495846 NPI number — ONE STOP PRESCRIPTION EL MONTE INC

Table of content: (NPI 1467495846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467495846 NPI number — ONE STOP PRESCRIPTION EL MONTE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE STOP PRESCRIPTION EL MONTE 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:
ONE STOP PRESCRIPTION
Provider Other Organization Name Type Code:
3
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:
1467495846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 AVE SIMON MADERA
Provider Second Line Business Mailing Address:
PARCELAS FALU
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00924-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-751-9606
Provider Business Mailing Address Fax Number:
787-751-0286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 AVE DE DIEGO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-977-2007
Provider Business Practice Location Address Fax Number:
787-977-2016
Provider Enumeration Date:
06/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VANGAFELICIANO
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-751-9606

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 18F2841 , 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)

  • Identifier: 2087423 . This is a "PK" identifier . This identifiers is of the category "OTHER".