Provider Demographics
NPI:1114907763
Name:FARMACIA LA AMISTAD INC
Entity Type:Organization
Organization Name:FARMACIA LA AMISTAD INC
Other - Org Name:FARMACIA LA AMISTAD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-780-2054
Mailing Address - Street 1:HC 1 BOX 8017
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-9740
Mailing Address - Country:US
Mailing Address - Phone:787-780-2054
Mailing Address - Fax:787-798-2125
Practice Address - Street 1:CARR 863 KM 2.0 BO PAJAROS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-780-2054
Practice Address - Fax:787-798-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17F17563336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085077OtherPK
2085077OtherPK