Provider Demographics
NPI:1073661633
Name:DRUG SHOPPE INC
Entity Type:Organization
Organization Name:DRUG SHOPPE INC
Other - Org Name:FARMACIA SAN JOSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-735-2401
Mailing Address - Street 1:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2021
Mailing Address - Country:US
Mailing Address - Phone:787-735-2401
Mailing Address - Fax:787-735-2500
Practice Address - Street 1:CALLE SAN JOSE
Practice Address - Street 2:STE 59
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-2401
Practice Address - Fax:787-735-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-32573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084551OtherPK