Provider Demographics
NPI:1407984610
Name:FARMACIA SAN ANTONIO
Entity Type:Organization
Organization Name:FARMACIA SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-2814
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-897-5075
Practice Address - Street 1:CARR. 129 INTERSECCION CARR. 111 CRUCE MIJAN
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0063
Practice Address - Country:US
Practice Address - Phone:787-897-2814
Practice Address - Fax:787-897-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F09753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy