Provider Demographics
NPI:1083640718
Name:FARMACIA ALEXANDRA
Entity Type:Organization
Organization Name:FARMACIA ALEXANDRA
Other - Org Name:FARMACIA ALEXANDRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-594-2125
Mailing Address - Street 1:PO BOX 20375
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0375
Mailing Address - Country:US
Mailing Address - Phone:787-767-4078
Mailing Address - Fax:787-758-3555
Practice Address - Street 1:1107 WILLIAM JONES ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-767-4078
Practice Address - Fax:787-758-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR12F22683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4006020OtherNCPDP PROVIDER IDENTIFICATION NUMBER