Provider Demographics
NPI:1366508152
Name:RICARDO GUERRERO
Entity Type:Organization
Organization Name:RICARDO GUERRERO
Other - Org Name:SUPER FARMACIA CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELITZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-257-8540
Mailing Address - Street 1:35-27 CALLE 16
Mailing Address - Street 2:VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5440
Mailing Address - Country:US
Mailing Address - Phone:787-257-8540
Mailing Address - Fax:787-257-6760
Practice Address - Street 1:35-27 CALLE 16
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5440
Practice Address - Country:US
Practice Address - Phone:787-257-8540
Practice Address - Fax:787-257-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1270332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3904240001Medicare NSC