1104965177 NPI number — BAYAMON MEDICAL PHARMACY & CAFETERIA,INC.

Table of content: (NPI 1104965177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104965177 NPI number — BAYAMON MEDICAL PHARMACY & CAFETERIA,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYAMON MEDICAL PHARMACY & CAFETERIA,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:
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:
1104965177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306
Provider Second Line Business Mailing Address:
CARR #2 KM. 11.2
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-0306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-786-8221
Provider Business Mailing Address Fax Number:
787-798-0333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR #2 KM 11.2
Provider Second Line Business Practice Location Address:
ANEXO HOSPITAL HNOS. MELENDEZ
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00960-0306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-786-8221
Provider Business Practice Location Address Fax Number:
787-798-0333
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALVAREZ
Authorized Official First Name:
ADALIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PHARMACIST
Authorized Official Telephone Number:
787-786-8221

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  07F0725 , 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)





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