Provider Demographics
NPI:1093872780
Name:RICARDO E FRONTERA BENVENUTTI
Entity Type:Organization
Organization Name:RICARDO E FRONTERA BENVENUTTI
Other - Org Name:FARMACIA EL EDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRONTERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-882-2000
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1827
Mailing Address - Country:US
Mailing Address - Phone:787-882-2000
Mailing Address - Fax:787-891-8614
Practice Address - Street 1:CARR. 110 KM. 22.7
Practice Address - Street 2:BO. CEIBA BAJA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-2000
Practice Address - Fax:787-891-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F17853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4018708OtherNCPDP OR NABP NUMBER
PR4746040001Medicare NSC