Provider Demographics
NPI:1497097513
Name:FARMACIA MI ANHELO
Entity Type:Organization
Organization Name:FARMACIA MI ANHELO
Other - Org Name:MI ANHELO CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-280-9032
Mailing Address - Street 1:PO BOX 2251
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-8251
Mailing Address - Country:US
Mailing Address - Phone:787-280-9032
Mailing Address - Fax:787-896-4640
Practice Address - Street 1:CARR 447 KM 3.8
Practice Address - Street 2:PLAZA ANIDEM SUITE 1
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-9032
Practice Address - Fax:787-896-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-33613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy