Provider Demographics
NPI:1225179328
Name:LASSALLE & VISSEPO INC
Entity Type:Organization
Organization Name:LASSALLE & VISSEPO INC
Other - Org Name:FARMACIA SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORO
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR DEGREE
Authorized Official - Phone:787-280-0606
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0643
Mailing Address - Country:US
Mailing Address - Phone:787-280-0606
Mailing Address - Fax:787-896-1177
Practice Address - Street 1:1488 AVE EMERITO ESTRADA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3023
Practice Address - Country:US
Practice Address - Phone:787-280-0606
Practice Address - Fax:787-896-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17F27243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085350OtherPK