Provider Demographics
NPI:1346456761
Name:BASIC PHARMACY
Entity Type:Organization
Organization Name:BASIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENCIADO
Authorized Official - Phone:787-751-8758
Mailing Address - Street 1:AVE MUNOZ RIVERA
Mailing Address - Street 2:PARADA 31
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-751-8758
Mailing Address - Fax:
Practice Address - Street 1:AVE MUNOZ RIVERA
Practice Address - Street 2:PARADA 31
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-751-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty