Provider Demographics
NPI:1194827048
Name:SUPER FARMACIA SAN ANTONIO
Entity Type:Organization
Organization Name:SUPER FARMACIA SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSAIDA
Authorized Official - Middle Name:TORRES
Authorized Official - Last Name:FIGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC 00214
Authorized Official - Phone:787-876-2705
Mailing Address - Street 1:CALLE AUTONOMIA #71
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3247
Mailing Address - Country:US
Mailing Address - Phone:787-876-2705
Mailing Address - Fax:787-876-0558
Practice Address - Street 1:CALLE AUTONOMIA #71
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3247
Practice Address - Country:US
Practice Address - Phone:787-876-2705
Practice Address - Fax:787-876-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1291230001Medicare ID - Type Unspecified