Provider Demographics
NPI:1053648618
Name:FARMACIA MEDICAL PLAZA
Entity Type:Organization
Organization Name:FARMACIA MEDICAL PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARYLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-286-1694
Mailing Address - Street 1:HC 8 BOX 39533
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #1 BARRIO TURABO CONSOLIDATED MALL
Practice Address - Street 2:LOCAL C 31C
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-286-1694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11-F-27743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy