1710290077 NPI number — FARMACIA JESIAH 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 1710290077 NPI number — FARMACIA JESIAH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA JESIAH 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:
1710290077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STREET E L11
Provider Second Line Business Mailing Address:
VISTA DEL PALMAR
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-463-3023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET E L11
Provider Second Line Business Practice Location Address:
VISTA DEL PALMAR
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-463-3023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
HERIBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY TECHNICIAN
Authorized Official Telephone Number:
787-463-3023

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , 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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