Provider Demographics
NPI:1487634101
Name:FARMACIA LA IDEAL, INC.
Entity Type:Organization
Organization Name:FARMACIA LA IDEAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST, CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:BSPH
Authorized Official - Phone:787-845-4692
Mailing Address - Street 1:4 CELIS AGUILERA ST.
Mailing Address - Street 2:P.O. BOX 139
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0139
Mailing Address - Country:US
Mailing Address - Phone:787-845-4690
Mailing Address - Fax:787-845-4731
Practice Address - Street 1:4 CALLE CELIS AGUILERA
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2622
Practice Address - Country:US
Practice Address - Phone:787-845-4690
Practice Address - Fax:787-845-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-0396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty