Provider Demographics
NPI:1366866675
Name:SAN PEDRO PHARMACY, CORP
Entity Type:Organization
Organization Name:SAN PEDRO PHARMACY, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER PHARMACIST
Authorized Official - Phone:787-720-2196
Mailing Address - Street 1:7 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5705
Mailing Address - Country:US
Mailing Address - Phone:787-720-2196
Mailing Address - Fax:787-287-8169
Practice Address - Street 1:7 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5705
Practice Address - Country:US
Practice Address - Phone:787-720-2196
Practice Address - Fax:787-287-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy