Provider Demographics
NPI:1174828461
Name:SUPER FARMACIA AMADEO INC
Entity Type:Organization
Organization Name:SUPER FARMACIA AMADEO INC
Other - Org Name:SUPER FARMACIA AMADEO INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-346-3146
Mailing Address - Street 1:SUPER FARMACIA AMADEO INC.
Mailing Address - Street 2:74 CARR. 670
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5155
Mailing Address - Country:US
Mailing Address - Phone:787-855-3473
Mailing Address - Fax:787-807-5533
Practice Address - Street 1:CARRETERA 670 KM 8.4
Practice Address - Street 2:SECTOR ALGARROBO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-3473
Practice Address - Fax:787-807-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR12-F29143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4027668OtherNCPDP PROVIDER IDENTIFICATION NUMBER