Provider Demographics
NPI:1073524641
Name:EXPRESS PHARMACY INC
Entity Type:Organization
Organization Name:EXPRESS PHARMACY INC
Other - Org Name:ESTEVES ESPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMENCITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-5151
Mailing Address - Street 1:HC 9 BOX 13327
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9027
Mailing Address - Country:US
Mailing Address - Phone:787-891-5151
Mailing Address - Fax:787-891-5151
Practice Address - Street 1:2 CARR 459
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-6200
Practice Address - Country:US
Practice Address - Phone:787-891-5151
Practice Address - Fax:787-891-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-2393333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087517OtherPK