1932574191 NPI number — FARMACIA ISLA VERDE

Table of content: (NPI 1932574191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932574191 NPI number — FARMACIA ISLA VERDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA ISLA VERDE
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:
1932574191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3409 AVE ISLA VERDE
Provider Second Line Business Mailing Address:
APT 602
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979-4970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-548-7559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 CALLE MAR AMARILLO MARGINAL VILLAMAR AO16
Provider Second Line Business Practice Location Address:
ISLA VERDE
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-548-7559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-548-7559

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  18-F-3407 , 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)