Provider Demographics
NPI:1518067172
Name:FARMACIA COMANDANTE LLC
Entity Type:Organization
Organization Name:FARMACIA COMANDANTE LLC
Other - Org Name:SUPER FARMACIA COMANDANTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LICENCIADO
Authorized Official - Phone:787-752-0315
Mailing Address - Street 1:932 CALLE CARMEN HERNANDEZ
Mailing Address - Street 2:URBANIZACION EL COMANDANTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3518
Mailing Address - Country:US
Mailing Address - Phone:787-752-0315
Mailing Address - Fax:787-257-7940
Practice Address - Street 1:932 CALLE CARMEN HERNANDEZ
Practice Address - Street 2:URBANIZACION EL COMANDANTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3518
Practice Address - Country:US
Practice Address - Phone:787-752-0315
Practice Address - Fax:787-257-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-0638333600000X
PR16-F-3198333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy