Provider Demographics
NPI:1356483705
Name:FARMACIA CORALIS INC
Entity Type:Organization
Organization Name:FARMACIA CORALIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-874-3122
Mailing Address - Street 1:PO BOX 97 NAGUABO, PR 00718-0097
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0097
Mailing Address - Country:US
Mailing Address - Phone:787-874-3122
Mailing Address - Fax:787-874-6819
Practice Address - Street 1:CALLE MUNOZ RIVERA #17
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-0097
Practice Address - Country:US
Practice Address - Phone:787-874-3122
Practice Address - Fax:787-874-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-21913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4015889OtherNCCDP