Provider Demographics
NPI:1578170460
Name:D & P LLC FARMACIA LA BOTICA
Entity Type:Organization
Organization Name:D & P LLC FARMACIA LA BOTICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:YARELIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-900-4660
Mailing Address - Street 1:55 CALLE CONFRATERNIDAD
Mailing Address - Street 2:URB PARAISO DE MAYAGUEZ
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-900-4660
Mailing Address - Fax:
Practice Address - Street 1:BO BORINQUEN CARR 107 KM 2.7 INT
Practice Address - Street 2:SUITE 1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0060
Practice Address - Country:US
Practice Address - Phone:787-551-3900
Practice Address - Fax:787-551-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038812500Medicaid