Provider Demographics
NPI:1093159683
Name:FARMACIA PLAZA ALTA, INC DBA FARMACIA MARILU
Entity Type:Organization
Organization Name:FARMACIA PLAZA ALTA, INC DBA FARMACIA MARILU
Other - Org Name:FARMACIA PLAZA ALTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-272-1205
Mailing Address - Street 1:AVE. RAMIREZ DE ARRELLANO 19-22 SUITE 1
Mailing Address - Street 2:CENTRO COMERCIAL TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-272-1205
Mailing Address - Fax:787-720-9379
Practice Address - Street 1:AVE. RAMIREZ DE ARRELLANO 19-22 SUITE 1
Practice Address - Street 2:CENTRO COMERCIAL TORRIMAR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-272-1205
Practice Address - Fax:787-720-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-F-3126333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15-F-3126OtherSTATE LICENSE