1639101231 NPI number — FSA RX LLC

Table of content: (NPI 1639101231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639101231 NPI number — FSA RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FSA RX LLC
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:
FSA RX LLC
Provider Other Organization Name Type Code:
4
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:
1639101231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-0523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-738-3010
Provider Business Mailing Address Fax Number:
787-738-6145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 AVE MUNOZ RIVERA N # 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-738-3010
Provider Business Practice Location Address Fax Number:
787-738-6145
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAMIREZ
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
GUILLERMO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-738-3010

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: 19F0484 , 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: 2082896 . This is a "PK" identifier . This identifiers is of the category "OTHER".