1477536852 NPI number — FARMACIA SAN MARTIN MANAT INC

Table of content: (NPI 1477536852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477536852 NPI number — FARMACIA SAN MARTIN MANAT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA SAN MARTIN MANAT 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:
1477536852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ESTANCIAS DE MANATI II # 153 CALLE DORADO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-7265
Provider Business Mailing Address Fax Number:
787-854-7265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA PUERTA DEL SOL #54, CARR #2, SUITE #3,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANAT
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-4445
Provider Business Practice Location Address Fax Number:
787-884-4444
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
MILDRED
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
787-884-4444

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  3920 , 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: 3920 . This is a "LIC. ESTADO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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