Provider Demographics
NPI:1467583328
Name:DAMAR OF PUERTO RICO SERVICES, INC.
Entity Type:Organization
Organization Name:DAMAR OF PUERTO RICO SERVICES, INC.
Other - Org Name:FARMACIA CDT DR. GUALBERTO RABELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:786-547-3240
Mailing Address - Street 1:PO BOX 25130
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-5130
Mailing Address - Country:US
Mailing Address - Phone:787-722-4600
Mailing Address - Fax:787-723-4068
Practice Address - Street 1:CALLE CERRA 900 FINAL
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-5104
Practice Address - Country:US
Practice Address - Phone:787-722-4600
Practice Address - Fax:787-723-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
PR17-F-31573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086936OtherPK