Provider Demographics
NPI:1114027141
Name:SAN ARCANGEL PHARMACY
Entity Type:Organization
Organization Name:SAN ARCANGEL PHARMACY
Other - Org Name:FARMACIA SAN ARCANGEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:787-744-3400
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0863
Mailing Address - Country:US
Mailing Address - Phone:787-744-3400
Mailing Address - Fax:787-258-3400
Practice Address - Street 1:2 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2603
Practice Address - Country:US
Practice Address - Phone:787-744-3400
Practice Address - Fax:787-258-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-0258183500000X
PR4015207332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07-F-0258OtherSTATE LICENCE P.R.
PR4470990001Medicare NSC