Provider Demographics
NPI:1417174293
Name:FARMACIA SAN ISIDRI ,INC.
Entity Type:Organization
Organization Name:FARMACIA SAN ISIDRI ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-256-0069
Mailing Address - Street 1:FARMACIA SAN ISIDRO CARRETERA 188 KILOMETRO 1,6 B-4
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA SAN ISIDRO CARRETERA 188 KILOMETRO 1,6 B-4
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-0069
Practice Address - Fax:787-256-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-15793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy