Provider Demographics
NPI:1508921230
Name:FARMACIA JARDINES DE LOIZA, INC.
Entity Type:Organization
Organization Name:FARMACIA JARDINES DE LOIZA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-876-3106
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0528
Mailing Address - Country:US
Mailing Address - Phone:787-876-3106
Mailing Address - Fax:787-876-5157
Practice Address - Street 1:CARR 188 # KM10.7
Practice Address - Street 2:URB. JARDINES DE LOIZA
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1850
Practice Address - Country:US
Practice Address - Phone:787-876-5157
Practice Address - Fax:787-876-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13-F-29433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4013227OtherNCPDP NUMBER
PRFF0818596OtherDEA