Provider Demographics
NPI:1518016872
Name:CONSTANCIA PHARMACY, INC.
Entity Type:Organization
Organization Name:CONSTANCIA PHARMACY, INC.
Other - Org Name:FARMACIA CONSTANCIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEYLA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:TRAVERSO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-849-1714
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0784
Mailing Address - Country:US
Mailing Address - Phone:787-849-1714
Mailing Address - Fax:787-849-1715
Practice Address - Street 1:CARR # 2 KM 166.4
Practice Address - Street 2:BO LAVADEROS
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-0784
Practice Address - Country:US
Practice Address - Phone:787-849-1714
Practice Address - Fax:787-849-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-22373336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5445170001Medicare ID - Type Unspecified