Provider Demographics
NPI:1558536235
Name:GEO DRUG STORE PHARMACY, INC.
Entity Type:Organization
Organization Name:GEO DRUG STORE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-3143
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0414
Mailing Address - Country:US
Mailing Address - Phone:787-854-3143
Mailing Address - Fax:787-884-7172
Practice Address - Street 1:CARR 149 # KM 1/3
Practice Address - Street 2:RPTO VILLA ALBERTA # 3
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-9670
Practice Address - Country:US
Practice Address - Phone:787-854-3143
Practice Address - Fax:787-884-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy