Provider Demographics
NPI:1093849705
Name:JENNY RIVERA FARMACIA LESMARIE
Entity Type:Organization
Organization Name:JENNY RIVERA FARMACIA LESMARIE
Other - Org Name:FARMACIA LESMARIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-784-3225
Mailing Address - Street 1:HA3 CALLE ANTONIO PAOLI
Mailing Address - Street 2:URB. LEVITOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3609
Mailing Address - Country:US
Mailing Address - Phone:787-784-3225
Mailing Address - Fax:787-784-3225
Practice Address - Street 1:HA3 CALLE ANTONIO PAOLI
Practice Address - Street 2:URB. LEVITOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3609
Practice Address - Country:US
Practice Address - Phone:787-784-3225
Practice Address - Fax:787-784-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F29343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085699OtherPK