1093159683 NPI number — FARMACIA PLAZA ALTA, INC DBA FARMACIA MARILU

Table of content: (NPI 1093159683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093159683 NPI number — FARMACIA PLAZA ALTA, INC DBA FARMACIA MARILU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA PLAZA ALTA, INC DBA FARMACIA MARILU
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:
1093159683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE. RAMIREZ DE ARRELLANO 19-22 SUITE 1
Provider Second Line Business Mailing Address:
CENTRO COMERCIAL TORRIMAR
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-272-1205
Provider Business Mailing Address Fax Number:
787-720-9379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. RAMIREZ DE ARRELLANO 19-22 SUITE 1
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL TORRIMAR
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-272-1205
Provider Business Practice Location Address Fax Number:
787-720-9379
Provider Enumeration Date:
04/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
LEIDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-272-1205

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  15-F-3126 , 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: 15-F-3126 . This is a "STATE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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