Provider Demographics
NPI:1093712838
Name:SUPER FARMACIA JUANA DIAZ
Entity Type:Organization
Organization Name:SUPER FARMACIA JUANA DIAZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-837-2139
Mailing Address - Street 1:27 CALLE TOMAS CARRION MADURO
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1642
Mailing Address - Country:US
Mailing Address - Phone:787-837-2139
Mailing Address - Fax:787-837-5911
Practice Address - Street 1:27 CALLE TOMAS CARRION MADURO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1642
Practice Address - Country:US
Practice Address - Phone:787-837-2139
Practice Address - Fax:787-837-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy