1366600207 NPI number — FARMACIA CENTRO PREVENCION Y TRATMIENTO DE

Table of content: (NPI 1366600207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366600207 NPI number — FARMACIA CENTRO PREVENCION Y TRATMIENTO DE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA CENTRO PREVENCION Y TRATMIENTO DE
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:
1366600207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 AVE HOSTOS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00682-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-2115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 2 # KM1570
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-2115
Provider Business Practice Location Address Fax Number:
787-832-6329
Provider Enumeration Date:
05/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BONILLA
Authorized Official First Name:
JANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY SUPRV
Authorized Official Telephone Number:
787-834-2115

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  10F2606 , 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: 4026349 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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