Provider Demographics
NPI:1497947840
Name:FAMILY PHARMACY
Entity Type:Organization
Organization Name:FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-826-2545
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:PMB 129
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0427
Mailing Address - Country:US
Mailing Address - Phone:787-546-4172
Mailing Address - Fax:888-464-0471
Practice Address - Street 1:65 CALLE 65 DE INFANTERIA
Practice Address - Street 2:SUITE B-101
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-546-4172
Practice Address - Fax:888-464-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-1663333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4021680OtherNCPDP
PR4021680OtherNCPDP