Provider Demographics
NPI:1215026349
Name:FARMACIA MEDINA #4 INC
Entity Type:Organization
Organization Name:FARMACIA MEDINA #4 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-256-3592
Mailing Address - Street 1:PO BOX 10000
Mailing Address - Street 2:SUITE 572
Mailing Address - City:CANORANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-3592
Mailing Address - Fax:787-256-0172
Practice Address - Street 1:CARR 185 KM 02 VRB ZONA INDUSTRIAL
Practice Address - Street 2:
Practice Address - City:CANORANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-3592
Practice Address - Fax:787-256-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F22963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4020424OtherNCPDP