Provider Demographics
NPI:1417517806
Name:BANUCHI, BEATRIZ
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:BANUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSION DEL RIO
Mailing Address - Street 2:NA1 VIA DEL RIO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-608-8249
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA MONTE REY
Practice Address - Street 2:CARR 694 KM 1.1 BO MONTE REY
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-0069
Practice Address - Country:US
Practice Address - Phone:787-270-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR03281OtherPHARMACIST ID
PR0941316OtherLICENCE
PR3281OtherPHARMACIST LICENCE NUMBER