Provider Demographics
NPI:1053087262
Name:AMAC SERVICE.LLC
Entity Type:Organization
Organization Name:AMAC SERVICE.LLC
Other - Org Name:FARMACIA PROVIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:MELETICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-673-0309
Mailing Address - Street 1:URB VISTAS DE MONTESOL
Mailing Address - Street 2:CALLE SATURNO #102
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-673-0309
Mailing Address - Fax:
Practice Address - Street 1:13 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-1830
Practice Address - Country:US
Practice Address - Phone:787-229-1515
Practice Address - Fax:787-229-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy