Provider Demographics
NPI:1366861346
Name:COOP. FCIA. STA. TERESITA
Entity Type:Organization
Organization Name:COOP. FCIA. STA. TERESITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-825-9432
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-0536
Mailing Address - Country:US
Mailing Address - Phone:787-825-9432
Mailing Address - Fax:787-803-1170
Practice Address - Street 1:25 CALLE JOSE I QUINTON
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2400
Practice Address - Country:US
Practice Address - Phone:787-825-9432
Practice Address - Fax:787-803-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty