1699947614 NPI number — FARMACIA SAGRADO CORAZON EXPRESS

Table of content: (NPI 1699947614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699947614 NPI number — FARMACIA SAGRADO CORAZON EXPRESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA SAGRADO CORAZON EXPRESS
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:
1699947614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB SANTA MARIA 139
Provider Second Line Business Mailing Address:
CALLE PEDRO DE ACOSTA
Provider Business Mailing Address City Name:
SABANA GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-873-1182
Provider Business Mailing Address Fax Number:
787-873-1182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ED DORA PAGANELLI LOCAL 2
Provider Second Line Business Practice Location Address:
AVE VICENTE QUILINCHINI
Provider Business Practice Location Address City Name:
SABANA GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-873-7676
Provider Business Practice Location Address Fax Number:
787-873-7373
Provider Enumeration Date:
03/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MIRANDA
Authorized Official First Name:
ILIANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
787-873-7676

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: 20F3348 , 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: 2087603 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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