Provider Demographics
NPI:1164537395
Name:FAMILIA CORTES-LEBRON, LLC
Entity Type:Organization
Organization Name:FAMILIA CORTES-LEBRON, LLC
Other - Org Name:FARMACIA SAN PEDRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-899-8719
Mailing Address - Street 1:3700 CARR 116
Mailing Address - Street 2:PMB # 101
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-9162
Mailing Address - Country:US
Mailing Address - Phone:787-899-8719
Mailing Address - Fax:787-899-8359
Practice Address - Street 1:CARR 116 INT CARR 304 KM 0.1
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-9162
Practice Address - Country:US
Practice Address - Phone:787-899-8719
Practice Address - Fax:787-899-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-F-31753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5510330001Medicare ID - Type Unspecified