Provider Demographics
NPI:1477720266
Name:RESTO PHARMACY INC
Entity Type:Organization
Organization Name:RESTO PHARMACY INC
Other - Org Name:RESTO PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-784-8400
Mailing Address - Street 1:PO BOX 51518
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1518
Mailing Address - Country:US
Mailing Address - Phone:787-784-8400
Mailing Address - Fax:787-784-8402
Practice Address - Street 1:J 24 AVE BLVD ESQ MIREYA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-8400
Practice Address - Fax:787-784-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
PR12F26053336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4026337OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PR6129590001Medicare NSC