Provider Demographics
NPI:1578628285
Name:MALEZA EXPRESS PHARMACY
Entity Type:Organization
Organization Name:MALEZA EXPRESS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARNADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-890-5505
Mailing Address - Street 1:HC-01 BOX 13327
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-890-5505
Mailing Address - Fax:787-890-5515
Practice Address - Street 1:CARR. 110 KM. 8.9
Practice Address - Street 2:BO. MALEZA ALTA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-890-5505
Practice Address - Fax:787-890-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-20273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5119860001Medicare ID - Type Unspecified