Provider Demographics
NPI:1043620123
Name:OWN BUSSINESS
Entity Type:Organization
Organization Name:OWN BUSSINESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-365-8662
Mailing Address - Street 1:1933 CALLE GUAYABO
Mailing Address - Street 2:LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-365-8662
Mailing Address - Fax:
Practice Address - Street 1:1933 CALLE GUAYABO
Practice Address - Street 2:LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-365-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR132035OtherREGISTER AND CERTIFICATION NUMBER (ACTIVE )