Provider Demographics
NPI:1255477816
Name:FARMACIA LAS COLINAS MAYAGUEZ INC
Entity Type:Organization
Organization Name:FARMACIA LAS COLINAS MAYAGUEZ INC
Other - Org Name:FARMACIA LAS COLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-613-3477
Mailing Address - Street 1:PO BOX 6066
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6066
Mailing Address - Country:US
Mailing Address - Phone:787-832-6122
Mailing Address - Fax:787-832-6074
Practice Address - Street 1:BO EL QUEMADO CARR 106 KM 5 8
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-6122
Practice Address - Fax:787-832-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR18F30813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087119OtherPK