Provider Demographics
NPI:1225044464
Name:ARMANDO RODRIGUEZ LOPEZ
Entity Type:Organization
Organization Name:ARMANDO RODRIGUEZ LOPEZ
Other - Org Name:SUPER FARMACIA JAYLEEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-882-1956
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0715
Mailing Address - Country:US
Mailing Address - Phone:787-882-1956
Mailing Address - Fax:
Practice Address - Street 1:SUPER FARMACIA JAYLLEN
Practice Address - Street 2:CARR 110, KM 0.3 BO. CEIBA BAJA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-1956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-14193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4019065OtherNCPDP