Provider Demographics
NPI:1568938496
Name:FARMACIA SAN JOSE MOCA LLC
Entity Type:Organization
Organization Name:FARMACIA SAN JOSE MOCA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:BABILONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-877-4370
Mailing Address - Street 1:PO BOX 1578
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1578
Mailing Address - Country:US
Mailing Address - Phone:787-877-4370
Mailing Address - Fax:
Practice Address - Street 1:56 CALLE DON CHEMARY
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4161
Practice Address - Country:US
Practice Address - Phone:787-877-4370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy