Provider Demographics
NPI:1497863575
Name:MEDICAL PHARMACY & LABORATORY ADMINISTRATIVE SERVICE CORP.
Entity Type:Organization
Organization Name:MEDICAL PHARMACY & LABORATORY ADMINISTRATIVE SERVICE CORP.
Other - Org Name:MPL ADMINISTRATIVE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ROBLEDO
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-707-1983
Mailing Address - Street 1:CALLE 8 ESQ 45 PARCELA FALU
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-763-3332
Mailing Address - Fax:
Practice Address - Street 1:CALLE 8 ESQ 45 PARCELA FALU
Practice Address - Street 2:
Practice Address - City:RIO PIEDRA
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-763-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSEGURO PATRONAL