Provider Demographics
NPI:1245394030
Name:FARMACIA NUEVA-HUMACAO LLC
Entity Type:Organization
Organization Name:FARMACIA NUEVA-HUMACAO LLC
Other - Org Name:FARMACIA NUEVA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMPARO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-852-0620
Mailing Address - Street 1:PO BOX 9108
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9108
Mailing Address - Country:US
Mailing Address - Phone:787-852-0620
Mailing Address - Fax:787-285-7243
Practice Address - Street 1:54 CALLE FONT MARTELO E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3603
Practice Address - Country:US
Practice Address - Phone:787-852-0620
Practice Address - Fax:787-285-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2989183500000X
PR3036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4001359OtherNCPDP
PR4001359OtherMED. PLAN PHARMACY NO.