1952446825 NPI number — FARMACIA SAN RAFAEL SANTURCE, INC

Table of content: (NPI 1952446825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952446825 NPI number — FARMACIA SAN RAFAEL SANTURCE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA SAN RAFAEL SANTURCE, 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:
1952446825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 CALLE LAFAYETTE
Provider Second Line Business Mailing Address:
PDA 20
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00909-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-724-3333
Provider Business Mailing Address Fax Number:
787-721-4165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
851 CALLE LAFAYETTE
Provider Second Line Business Practice Location Address:
PDA 20
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-724-3333
Provider Business Practice Location Address Fax Number:
787-721-4165
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ REYES
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
ANGEL
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-724-3333

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  17-F-2298 , 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: 17-F-2298 . This is a "STATE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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