1891819348 NPI number — FARMACIA DEL PUEBLO DE VEGA ALTA, INC.

Table of content: ANDREW BRADY COLLEY RN (NPI 1205225513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891819348 NPI number — FARMACIA DEL PUEBLO DE VEGA ALTA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA DEL PUEBLO DE VEGA ALTA, 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:
1891819348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 AVE LA SIERRA APT 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-883-2065
Provider Business Mailing Address Fax Number:
787-623-8599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 2 KM 30. 1 BO. ESPINOZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-883-2065
Provider Business Practice Location Address Fax Number:
787-623-8599
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARRERO MEDINA
Authorized Official First Name:
SOFIA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-883-2065

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  08F2462 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4021894 . This is a "NABP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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