Provider Demographics
NPI:1578648713
Name:LETTY'S PHARMACY
Entity Type:Organization
Organization Name:LETTY'S PHARMACY
Other - Org Name:LETTY'S PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-614-4446
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1690
Mailing Address - Country:US
Mailing Address - Phone:787-899-1476
Mailing Address - Fax:787-899-1710
Practice Address - Street 1:CALLE 65TH INFANTERIA NO. 74 SUR
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-1690
Practice Address - Country:US
Practice Address - Phone:787-899-1476
Practice Address - Fax:787-899-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12F28633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12F2863OtherPUERTO RICO LICENSE
4004204OtherNCPDP
FLFL2182210OtherDEA