Provider Demographics
NPI:1417369679
Name:NUEVA FARMACIA SANTA ANA, INC.
Entity Type:Organization
Organization Name:NUEVA FARMACIA SANTA ANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-2503
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0547
Mailing Address - Country:US
Mailing Address - Phone:787-270-2503
Mailing Address - Fax:787-270-2518
Practice Address - Street 1:B3 CALLE 1
Practice Address - Street 2:URBANIZACION SANTA ANA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-2503
Practice Address - Fax:787-270-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16-F-31913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy