1033246806 NPI number — PROFESSIONAL DRUG 1

Table of content: (NPI 1033246806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033246806 NPI number — PROFESSIONAL DRUG 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL DRUG 1
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:
1033246806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51666
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00950-1666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-870-0978
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B35 CALLE 6
Provider Second Line Business Practice Location Address:
URB SANFERNANDO
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-870-2935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
NILZA
Authorized Official Middle Name:
IRIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-870-2935

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  15-F-0813 , 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: 4019724 . This is a "NCPDP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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