Provider Demographics
NPI:1497803456
Name:JORGE RODRIGUEZ FREITAS
Entity Type:Organization
Organization Name:JORGE RODRIGUEZ FREITAS
Other - Org Name:FARMACIA DE TODOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA DE LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ CARTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-737-3355
Mailing Address - Street 1:SAN JOSE ST 4 NORTH
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-737-3355
Mailing Address - Fax:
Practice Address - Street 1:SAN JOSE ST 4 NORTH
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-3355
Practice Address - Fax:787-737-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F13003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085346OtherPK