1902546138 NPI number — CACAO PHARMA EXPRESS LLC

Table of content: (NPI 1902546138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902546138 NPI number — CACAO PHARMA EXPRESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CACAO PHARMA EXPRESS 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:
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:
1902546138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2387 CALLE LORENZO CABRERA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-2941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-699-9090
Provider Business Mailing Address Fax Number:
787-895-2244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 477 KM 1.5
Provider Second Line Business Practice Location Address:
BO. CACAO
Provider Business Practice Location Address City Name:
QUEBRADILLAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00678-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-699-9090
Provider Business Practice Location Address Fax Number:
787-895-2244
Provider Enumeration Date:
03/29/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ VILLANUEVA
Authorized Official First Name:
ZUJEIDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY TECHNICIAN
Authorized Official Telephone Number:
787-295-6487

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 039302700 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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