1104248061 NPI number — RAMEY SUPER PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104248061 NPI number — RAMEY SUPER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMEY SUPER PHARMACY
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:
1104248061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 RAMEY SHOPPING CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-1262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BELT 703
Provider Second Line Business Practice Location Address:
RAMEY SHOPPING CENTER
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-890-5222
Provider Business Practice Location Address Fax Number:
787-890-4022
Provider Enumeration Date:
01/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVENCIA
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
787-890-5222

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  15-F-3176 , 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: 2143805 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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