Provider Demographics
NPI:1336123322
Name:EMPRESAS BONILLA COLON INC
Entity Type:Organization
Organization Name:EMPRESAS BONILLA COLON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-847-8600
Mailing Address - Street 1:PO BOX 1542
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1542
Mailing Address - Country:US
Mailing Address - Phone:787-847-8600
Mailing Address - Fax:787-847-3336
Practice Address - Street 1:CARR 149 KM 56.7
Practice Address - Street 2:SECTOR TIERRA SANTA
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-3401
Practice Address - Country:US
Practice Address - Phone:787-847-8600
Practice Address - Fax:787-847-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5559900001332B00000X
PR19-F-23153336C0003X
333600000X
PR17F23153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4007078OtherNABP
2084061OtherPK