Provider Demographics
NPI:1114379211
Name:CONSOLIDATED PHARMACY, INC.
Entity Type:Organization
Organization Name:CONSOLIDATED PHARMACY, INC.
Other - Org Name:CONSOLIDATED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-957-2388
Mailing Address - Street 1:CALLE LAS PIEDRAS
Mailing Address - Street 2:#35 BONNEVILLE HEIGTH
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-957-2388
Mailing Address - Fax:787-957-1873
Practice Address - Street 1:CONSOLIDATED MALL
Practice Address - Street 2:LOCAL C-24
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-957-2388
Practice Address - Fax:787-957-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR18F33623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160826OtherPK