Provider Demographics
NPI:1033246806
Name:PROFESSIONAL DRUG 1
Entity Type:Organization
Organization Name:PROFESSIONAL DRUG 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILZA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-870-2935
Mailing Address - Street 1:PO BOX 51666
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1666
Mailing Address - Country:US
Mailing Address - Phone:787-870-0978
Mailing Address - Fax:
Practice Address - Street 1:B35 CALLE 6
Practice Address - Street 2:URB SANFERNANDO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2205
Practice Address - Country:US
Practice Address - Phone:787-870-2935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-F-0813333600000X
PR07F08133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4019724OtherNCPDP