Provider Demographics
NPI:1114969789
Name:GLADYS VELEZ MORALES
Entity Type:Organization
Organization Name:GLADYS VELEZ MORALES
Other - Org Name:SUPER FARMACIA FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ- MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-877-7322
Mailing Address - Street 1:PO BOX 1563
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1563
Mailing Address - Country:US
Mailing Address - Phone:787-877-7322
Mailing Address - Fax:787-877-3342
Practice Address - Street 1:CARR 420 KM 0.5 BO VOLADORAS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-7322
Practice Address - Fax:787-877-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19-F-01963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084662OtherPK