Provider Demographics
NPI:1518383231
Name:MAYRA'S PHARMACY PSC
Entity Type:Organization
Organization Name:MAYRA'S PHARMACY PSC
Other - Org Name:MAYRA'S PHARMACY PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:IVELISSE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-874-9911
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0741
Mailing Address - Country:US
Mailing Address - Phone:787-874-9911
Mailing Address - Fax:787-874-3582
Practice Address - Street 1:CARR. 31 KM. 3.2
Practice Address - Street 2:AT SUPERMERCADOS ECONO
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-0741
Practice Address - Country:US
Practice Address - Phone:787-874-9911
Practice Address - Fax:787-874-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR15F31783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144520OtherPK