Provider Demographics
NPI:1356642292
Name:ONE STOP PRESCRIPTION GUAYNABO INC
Entity Type:Organization
Organization Name:ONE STOP PRESCRIPTION GUAYNABO INC
Other - Org Name:FARMACIA ONE STOP PRESCRIPTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGA FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-710-6495
Mailing Address - Street 1:730 CALLE JULIO ANDINO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2252
Mailing Address - Country:US
Mailing Address - Phone:787-751-9606
Mailing Address - Fax:787-751-0286
Practice Address - Street 1:CALLE ESMERALDA ESQ. CALLE D
Practice Address - Street 2:SUPERMAX PLAZA GUAYNABO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-708-3800
Practice Address - Fax:787-708-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR12-F-28993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4027579OtherNCPDP PROVIDER IDENTIFICATION NUMBER