Provider Demographics
NPI:1053512764
Name:FARMACIA LISYAI, INC.
Entity Type:Organization
Organization Name:FARMACIA LISYAI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-608-6499
Mailing Address - Street 1:AI5 CALLE 2
Mailing Address - Street 2:VILLA DEL CARMEN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-737-1133
Mailing Address - Fax:787-737-0793
Practice Address - Street 1:AI5 CALLE 2
Practice Address - Street 2:VILLA DEL CARMEN
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2120
Practice Address - Country:US
Practice Address - Phone:787-737-1133
Practice Address - Fax:787-737-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09F25173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy