1679642789 NPI number — ONE STOP PRESCRIPTION PLAZA FAJARDO

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 1679642789 NPI number — ONE STOP PRESCRIPTION PLAZA FAJARDO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE STOP PRESCRIPTION PLAZA FAJARDO
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 PLAZA FAJARDO
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:
1679642789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 CARR 940 STE 10
Provider Second Line Business Mailing Address:
FAJARDO PR
Provider Business Mailing Address City Name:
FAJARDO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00738-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-863-3080
Provider Business Mailing Address Fax Number:
787-863-3440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR #3 CARR 940 QUEBRADA FAJARDO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-863-3080
Provider Business Practice Location Address Fax Number:
787-863-3440
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-863-3080

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: 17F2140 , 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: 2087239 . This is a "PK" identifier . This identifiers is of the category "OTHER".