Provider Demographics
NPI:1518011758
Name:SUPER FARMACIA ARZUAGA INC
Entity Type:Organization
Organization Name:SUPER FARMACIA ARZUAGA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:787-767-2626
Mailing Address - Street 1:CAROLINA SHOPPING COURT
Mailing Address - Street 2:LOCAL 103-B CARR#3 ESQ ROBERTO CLEMENTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-767-2626
Mailing Address - Fax:787-767-2626
Practice Address - Street 1:CAROLINA SHOPPING COURT 1
Practice Address - Street 2:LOCAL 103-B CARR#3 ESQ ROBERTO CLEMENTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-767-2626
Practice Address - Fax:787-767-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-03073336C0003X
PR20F35543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4016641OtherNCPDP