Provider Demographics
NPI:1083736946
Name:FARMACIA SAN ANTONIO DE PADUA
Entity Type:Organization
Organization Name:FARMACIA SAN ANTONIO DE PADUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-614-9124
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9000
Mailing Address - Country:US
Mailing Address - Phone:787-280-1330
Mailing Address - Fax:787-280-1330
Practice Address - Street 1:CARR 435 KM 4 2
Practice Address - Street 2:BARRIO CALABAZA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-9000
Practice Address - Country:US
Practice Address - Phone:787-280-1330
Practice Address - Fax:787-280-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR590M-06333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy