Provider Demographics
NPI:1154458743
Name:FARMACIA DON LUIS DE GUAYNABO INC
Entity Type:Organization
Organization Name:FARMACIA DON LUIS DE GUAYNABO INC
Other - Org Name:FARMACIA DOS BOCAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-383-1926
Mailing Address - Street 1:HC 645 BOX 5198
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-9759
Mailing Address - Country:US
Mailing Address - Phone:787-283-1920
Mailing Address - Fax:787-755-3278
Practice Address - Street 1:CARR 181 KM 9 1 BO DOS BOCAS
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-283-1920
Practice Address - Fax:787-755-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17F20973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084670OtherPK