Provider Demographics
NPI:1467498261
Name:FARMACIA GRANDE DORADO
Entity Type:Organization
Organization Name:FARMACIA GRANDE DORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHCY DIR
Authorized Official - Prefix:
Authorized Official - First Name:LINNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLELLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-638-8955
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00963-0458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:693 ROAD KM 8
Practice Address - Street 2:DORADO DEL MAR SHP CNTR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-278-6011
Practice Address - Fax:787-278-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F2319333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4025119OtherOTHER ID NUMBER-COMMERCIAL NUMBER