Provider Demographics
NPI:1013034313
Name:VIDOT RX LLC
Entity Type:Organization
Organization Name:VIDOT RX LLC
Other - Org Name:FARMACIA KEITHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDOT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-346-7801
Mailing Address - Street 1:PO BOX 140358
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0358
Mailing Address - Country:US
Mailing Address - Phone:787-878-1800
Mailing Address - Fax:787-878-8042
Practice Address - Street 1:109 CENTRO COMERCIAL VISTA AZUL
Practice Address - Street 2:
Practice Address - City:ARCIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-1800
Practice Address - Fax:787-878-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
PR15F04943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038598900Medicaid
2084401OtherPK