Provider Demographics
NPI:1326160417
Name:FARMACIA AMADEO
Entity Type:Organization
Organization Name:FARMACIA AMADEO
Other - Org Name:FARMACIA AMADEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-3140
Mailing Address - Street 1:PO BOX 366235
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6235
Mailing Address - Country:US
Mailing Address - Phone:787-883-3140
Mailing Address - Fax:787-883-3140
Practice Address - Street 1:72 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6528
Practice Address - Country:US
Practice Address - Phone:787-883-3140
Practice Address - Fax:787-883-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-00303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2082730OtherPK