1578772356 NPI number — MEDICAL PHARMACY AND LAB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578772356 NPI number — MEDICAL PHARMACY AND LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL PHARMACY AND LAB
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:
1578772356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/21/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
771 AVE ANDALUCIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUERTO NUEVO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-707-1983
Provider Business Mailing Address Fax Number:
787-706-8823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA ANDGLUCIA 771 PUERTO NUEVO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-707-1943
Provider Business Practice Location Address Fax Number:
787-706-8823
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBLEDO
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-707-1983

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , 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)