Provider Demographics
NPI:1174651475
Name:SU FARMACIA MODELO Z.P. INC.
Entity Type:Organization
Organization Name:SU FARMACIA MODELO Z.P. INC.
Other - Org Name:FARMACIA MODELO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-896-1154
Mailing Address - Street 1:ST. 5 # D30 URB. VENTURINI
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-896-5954
Mailing Address - Fax:
Practice Address - Street 1:M.J. CABRERO 54
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0030183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003018OtherTECHNICIAN