1588720585 NPI number — FARMACIA DIAZ CORP

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 1588720585 NPI number — FARMACIA DIAZ CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA DIAZ CORP
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:
FARMACIA DIAZ
Provider Other Organization Name Type Code:
3
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:
1588720585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/08/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 959
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRANQUITAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00794-0959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-857-7954
Provider Business Mailing Address Fax Number:
787-857-5249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 152 KM 2.8
Provider Second Line Business Practice Location Address:
BARRIO QUEBRADILLAS
Provider Business Practice Location Address City Name:
BARRANQUITAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-857-7954
Provider Business Practice Location Address Fax Number:
787-857-5249
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIRADA
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
787-857-7954

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: 13F2108 , 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: 4024167 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5234100001 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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