1023364528 NPI number — PRESCRIPTION HEALTH RESOURCES OF PUERTO RICO LLC

Table of content: (NPI 1023364528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023364528 NPI number — PRESCRIPTION HEALTH RESOURCES OF PUERTO RICO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESCRIPTION HEALTH RESOURCES OF PUERTO RICO 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:
6
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:
1023364528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
A1 CALLE ARPEGIO # 2
Provider Second Line Business Mailing Address:
HIGHLAND GARDENS
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-545-2073
Provider Business Mailing Address Fax Number:
787-545-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A1 CALLE ARPEGIO # 2
Provider Second Line Business Practice Location Address:
HIGHLAND GARDENS
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-545-2073
Provider Business Practice Location Address Fax Number:
787-545-4702
Provider Enumeration Date:
08/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NEVAREZ
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
787-545-2073

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  17F3300 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2137829 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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