Provider Demographics
NPI:1275661472
Name:PROFESSIONAL DRUG # 2
Entity Type:Organization
Organization Name:PROFESSIONAL DRUG # 2
Other - Org Name:NILZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILZA
Authorized Official - Middle Name:I
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-883-4295
Mailing Address - Street 1:PO BOX 51666
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1666
Mailing Address - Country:US
Mailing Address - Phone:787-870-2935
Mailing Address - Fax:787-870-7939
Practice Address - Street 1:ROAD 693 ESQUINA CALLE 7
Practice Address - Street 2:BO BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-4295
Practice Address - Fax:787-270-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F18953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy