Provider Demographics
NPI:1003989831
Name:FARMACIA DORAL, INC.
Entity Type:Organization
Organization Name:FARMACIA DORAL, INC.
Other - Org Name:AXIUM HEALTHCARE PUERTO RICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-733-3126
Mailing Address - Street 1:3200 LAKE EMMA RD.
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:855-733-3126
Mailing Address - Fax:888-315-3270
Practice Address - Street 1:1001 CALLE SAN ROBERTO, STE 101
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2758
Practice Address - Country:UM
Practice Address - Phone:787-780-7200
Practice Address - Fax:787-779-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5022620001332B00000X
PR18-F-2882333600000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1003989831OtherNCPA
PR5022620001Medicare NSC