Provider Demographics
NPI:1255476644
Name:FARMACIA SAN MIGUEL
Entity Type:Organization
Organization Name:FARMACIA SAN MIGUEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ISMAEL
Authorized Official - Last Name:SAN MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1787-858-5257
Mailing Address - Street 1:54 CALLE E BETANCES
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4407
Mailing Address - Country:US
Mailing Address - Phone:178-785-8526
Mailing Address - Fax:178-785-8156
Practice Address - Street 1:54 CALLE E BETANCES
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4407
Practice Address - Country:US
Practice Address - Phone:787-858-5267
Practice Address - Fax:787-858-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F04603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy