Provider Demographics
NPI:1477529659
Name:RX DEPOT, INC.
Entity Type:Organization
Organization Name:RX DEPOT, INC.
Other - Org Name:LA BOTICA DE MI ABUELA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-708-2375
Mailing Address - Street 1:271 CALLE SIERRA MORENA
Mailing Address - Street 2:LA CUMBRE MSC 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5539
Mailing Address - Country:US
Mailing Address - Phone:787-708-2375
Mailing Address - Fax:787-783-3060
Practice Address - Street 1:27 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5715
Practice Address - Country:US
Practice Address - Phone:787-708-2375
Practice Address - Fax:787-783-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-2264332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07-F-2264OtherPHARMACY LICENSE
PR07-F-2264OtherPHARMACY LICENSE