Provider Demographics
NPI:1326188053
Name:METRO MAYAGUEZ, INC.
Entity Type:Organization
Organization Name:METRO MAYAGUEZ, INC.
Other - Org Name:FARMACIA PEREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAESTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-834-0101
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0170
Mailing Address - Country:US
Mailing Address - Phone:787-834-0101
Mailing Address - Fax:787-265-2455
Practice Address - Street 1:5 CALLE DE DIEGO E
Practice Address - Street 2:ESQUINA DR. BASORA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4811
Practice Address - Country:US
Practice Address - Phone:787-832-3208
Practice Address - Fax:787-832-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08-F-2466333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4024686OtherNCPDP