Provider Demographics
NPI:1568722783
Name:CORP FONDE DEL SEGURO DEL ESTADO
Entity Type:Organization
Organization Name:CORP FONDE DEL SEGURO DEL ESTADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:MACCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-864-0095
Mailing Address - Street 1:AVE PEDRO ALBIZU CAMPOS DESVIO SUR CARR #3
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-1199
Mailing Address - Country:US
Mailing Address - Phone:787-864-0095
Mailing Address - Fax:787-864-7006
Practice Address - Street 1:AVE PEDRO ALBIZU CAMPOS DESVIO SUR CARR #3
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-1199
Practice Address - Country:US
Practice Address - Phone:787-864-0095
Practice Address - Fax:787-864-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26703336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy