1720185655 NPI number — FARMACIA EL DIVINO NINO LLC

Table of content: (NPI 1720185655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720185655 NPI number — FARMACIA EL DIVINO NINO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA EL DIVINO NINO LLC
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:
1720185655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 CALLE CONCEPCION VERA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00676-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-818-4839
Provider Business Mailing Address Fax Number:
787-877-8129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 110 KM 10.5
Provider Second Line Business Practice Location Address:
835 CONCEPCION VERA
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-818-4839
Provider Business Practice Location Address Fax Number:
787-877-8129
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
XOCHITL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
787-818-4839

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 17-F-2289 , 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: 2087087 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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