Provider Demographics
NPI:1225784143
Name:BIENESTAR PHARMACY GROUP
Entity Type:Organization
Organization Name:BIENESTAR PHARMACY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:RODRIGUEZ-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:939-545-0522
Mailing Address - Street 1:165 CALLE BALDRIOTY NORTE
Mailing Address - Street 2:BUZON #2
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:939-545-0522
Mailing Address - Fax:939-545-0700
Practice Address - Street 1:CARR 718, KM. 1.1
Practice Address - Street 2:BO PASTO
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-303-0799
Practice Address - Fax:787-333-6188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIENESTAR PHARMACY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MG909OtherMEDICARE