1659404697 NPI number — FARMACIA TRES HERMANOS INC

Table of content: (NPI 1659404697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659404697 NPI number — FARMACIA TRES HERMANOS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA TRES HERMANOS 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:
1659404697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARR 401 TRES HERMANOS
Provider Second Line Business Mailing Address:
BO PLAYA CARR 401 KM0.9
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-826-6453
Provider Business Mailing Address Fax Number:
787-826-6453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 401 TRES HERMANOS
Provider Second Line Business Practice Location Address:
BO PLAYA CARR 401 KM0.9
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-826-6453
Provider Business Practice Location Address Fax Number:
787-826-6453
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
LEIDA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRADORA
Authorized Official Telephone Number:
787-826-6453

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5631-06 , 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: 4025323 . This is a "NADP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 157774 . This is a "REGISTRO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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