Provider Demographics
NPI:1457481475
Name:FARMACIA AVILES
Entity Type:Organization
Organization Name:FARMACIA AVILES
Other - Org Name:FARMACIA AVILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-885-2525
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-0225
Mailing Address - Country:US
Mailing Address - Phone:787-885-2525
Mailing Address - Fax:787-885-2525
Practice Address - Street 1:250 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2707
Practice Address - Country:US
Practice Address - Phone:787-885-2525
Practice Address - Fax:787-885-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09F-02363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4328450001Medicare ID - Type Unspecified