Provider Demographics
NPI:1275865750
Name:PHARMACY EXPRESS
Entity Type:Organization
Organization Name:PHARMACY EXPRESS
Other - Org Name:PHARMACY EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IZETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEL MORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-657-3555
Mailing Address - Street 1:P.O. BOX 8578
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-657-3555
Mailing Address - Fax:787-657-3550
Practice Address - Street 1:CARR #3 KM 24.5 PLAZA RIO GRANDE BO. GUZMAN ABAJO
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-657-3555
Practice Address - Fax:787-657-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-27873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166795OtherPK