Provider Demographics
NPI:1376675850
Name:FARMACIA COOPERATIVA
Entity Type:Organization
Organization Name:FARMACIA COOPERATIVA
Other - Org Name:FARMACIA COOPERATIVA DE LARES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:BS PH
Authorized Official - Phone:787-897-2464
Mailing Address - Street 1:23 CALLE RAMON DE JESUS
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-2204
Mailing Address - Country:US
Mailing Address - Phone:787-897-2464
Mailing Address - Fax:787-897-3231
Practice Address - Street 1:23 CALLE RAMON DE JESUS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2204
Practice Address - Country:US
Practice Address - Phone:787-897-2464
Practice Address - Fax:787-897-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDF009969333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4012097OtherNAPB