1053523100 NPI number — FARMACIA DE MARIANAS

Table of content: (NPI 1053523100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053523100 NPI number — FARMACIA DE MARIANAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA DE MARIANAS
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:
1053523100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-646-9696
Provider Business Mailing Address Fax Number:
671-649-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 CHALAN GUMAYUOS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-646-9696
Provider Business Practice Location Address Fax Number:
671-649-6601
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUZMAN
Authorized Official First Name:
MARIA LUZ
Authorized Official Middle Name:
BALUYOT
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
671-646-9696

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PCY004 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5410713 . This is a "NCPDP NABP" identifier . This identifiers is of the category "OTHER".




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