1255456430 NPI number — B52 RX GROUP LLC

Table of content: (NPI 1255456430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255456430 NPI number — B52 RX GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B52 RX GROUP LLC
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:
1255456430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAJAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00667-0215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-899-1693
Provider Business Mailing Address Fax Number:
787-899-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 65 INFANTERIA
Provider Second Line Business Practice Location Address:
# 13 C
Provider Business Practice Location Address City Name:
LAJAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-899-1693
Provider Business Practice Location Address Fax Number:
787-899-1693
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
BERNICE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
787-899-1693

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: 19F3153 , 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: 2144852 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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