Provider Demographics
NPI:1144241449
Name:COOPHARMA INTEGRATED SOLUTION
Entity Type:Organization
Organization Name:COOPHARMA INTEGRATED SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:HIRAM
Authorized Official - Last Name:CALLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-969-0196
Mailing Address - Street 1:CARR.165 CENTRO CIBERNETICO ZONA LIBRE DE COMERCIO
Mailing Address - Street 2:BO. AMELIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:939-969-0196
Mailing Address - Fax:
Practice Address - Street 1:165 AVE. BO. AMELIA CENTRO CIBERNETICO ZONA LIBRE DE E
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:939-969-0196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization