Provider Demographics
NPI:1093792202
Name:FARMACIA SAN PABLO, INC.
Entity Type:Organization
Organization Name:FARMACIA SAN PABLO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-739-8300
Mailing Address - Street 1:64 CALLE BARCELO
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3438
Mailing Address - Country:US
Mailing Address - Phone:787-739-8300
Mailing Address - Fax:787-739-6300
Practice Address - Street 1:64 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3438
Practice Address - Country:US
Practice Address - Phone:787-739-8300
Practice Address - Fax:787-739-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-05593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNABP-4017035OtherPHARMACY