1750500302 NPI number — FARMACIA MEDIANIA INC

Table of content: (NPI 1750500302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750500302 NPI number — FARMACIA MEDIANIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA MEDIANIA 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:
6
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:
1750500302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 528
Provider Second Line Business Mailing Address:
LOIZA
Provider Business Mailing Address City Name:
LOIZA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00772-0528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-876-1927
Provider Business Mailing Address Fax Number:
787-256-2777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 187 KM 7.0
Provider Second Line Business Practice Location Address:
MEDIANIA ALTA
Provider Business Practice Location Address City Name:
LOIZA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-876-1927
Provider Business Practice Location Address Fax Number:
787-256-2777
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOLINA
Authorized Official First Name:
SANTIAGO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-876-1927

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  13-F-0629 , 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: 4014433 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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