1073524641 NPI number — EXPRESS PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073524641 NPI number — EXPRESS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPRESS PHARMACY 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:
ESTEVES ESPRESS PHARMACY
Provider Other Organization Name Type Code:
3
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:
1073524641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 9 BOX 13327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-9027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-891-5151
Provider Business Mailing Address Fax Number:
787-891-5151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CARR 459
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-891-5151
Provider Business Practice Location Address Fax Number:
787-891-5151
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NIEVES
Authorized Official First Name:
CARMENCITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-891-5151

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  18-F-2393 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2087517 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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