Provider Demographics
NPI:1003134602
Name:CENTRO ARARAT INC
Entity Type:Organization
Organization Name:CENTRO ARARAT INC
Other - Org Name:C A PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-284-5884
Mailing Address - Street 1:8169 CALLE CONCORDIA STE 412
Mailing Address - Street 2:COND. SAN VICENTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1567
Mailing Address - Country:US
Mailing Address - Phone:787-284-4488
Mailing Address - Fax:787-284-4445
Practice Address - Street 1:8169 CALLE CONCORDIA STE 410
Practice Address - Street 2:COND SAN VICENTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1567
Practice Address - Country:US
Practice Address - Phone:787-284-4488
Practice Address - Fax:787-284-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336M0002X
PR20-F-28423336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124873OtherPK