Provider Demographics
NPI:1437274966
Name:FARMACIA DORAVILLE
Entity Type:Organization
Organization Name:FARMACIA DORAVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-3310
Mailing Address - Street 1:1-14 SECTION 1 URB DORAVILLE
Mailing Address - Street 2:FARMACIA DORAVILLE
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5908
Mailing Address - Country:US
Mailing Address - Phone:787-796-3310
Mailing Address - Fax:787-796-3310
Practice Address - Street 1:1-1#14 URB DORAVILLE
Practice Address - Street 2:FARMACIA DORAVILLE
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5908
Practice Address - Country:US
Practice Address - Phone:787-796-3310
Practice Address - Fax:787-796-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1485164183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1485164OtherP R DRIVERS LICENCE