1174828461 NPI number — SUPER FARMACIA AMADEO INC

Table of content: (NPI 1174828461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174828461 NPI number — SUPER FARMACIA AMADEO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPER FARMACIA AMADEO 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:
1174828461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUPER FARMACIA AMADEO INC.
Provider Second Line Business Mailing Address:
74 CARR. 670
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693-5155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-855-3473
Provider Business Mailing Address Fax Number:
787-807-5533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 670 KM 8.4
Provider Second Line Business Practice Location Address:
SECTOR ALGARROBO
Provider Business Practice Location Address City Name:
VEGA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-855-3473
Provider Business Practice Location Address Fax Number:
787-807-5533
Provider Enumeration Date:
01/18/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-346-3146

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: 12-F2914 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4027668 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".