1578627303 NPI number — SU FARMACIA MODELO Z P INC

Table of content: (NPI 1578627303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578627303 NPI number — SU FARMACIA MODELO Z P INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SU FARMACIA MODELO Z P 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:
FARMACIA MODELO
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:
1578627303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-896-1154
Provider Business Mailing Address Fax Number:
787-896-1154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE MJ CABRERO
Provider Second Line Business Practice Location Address:
SUITE 54
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-1154
Provider Business Practice Location Address Fax Number:
787-896-1154
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ TORRES
Authorized Official First Name:
NILSA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-896-1154

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  18-F-3079 , 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: 2139535 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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