1063789600 NPI number — PHARMACARE, INC.

Table of content: (NPI 1063789600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063789600 NPI number — PHARMACARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACARE, 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:
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:
1063789600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 260310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-692-2449
Provider Business Mailing Address Fax Number:
787-287-7800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CALLE TAPIA
Provider Second Line Business Practice Location Address:
ESQ GILBERTO MONROIG
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-982-6969
Provider Business Practice Location Address Fax Number:
787-982-6767
Provider Enumeration Date:
11/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AYALA
Authorized Official First Name:
ANELIESE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICEPRESIDENTA
Authorized Official Telephone Number:
787-692-2449

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 13F2985 , 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: 4028038 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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