1902247349 NPI number — PRESTAMO PHARMACY

Table of content: (NPI 1902247349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902247349 NPI number — PRESTAMO PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESTAMO PHARMACY
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:
1902247349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 682
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00951-0682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-644-8663
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 867 KM 5.4
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-644-8663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PRESTAMO
Authorized Official First Name:
JOSEFINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY
Authorized Official Telephone Number:
787-644-8663

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 15-F-3142 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4028595 . This is a "NCPCP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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