Provider Demographics
NPI:1588003420
Name:LYDIA E. MATOS COLON
Entity Type:Organization
Organization Name:LYDIA E. MATOS COLON
Other - Org Name:FARMACIA LUJAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-762-3200
Mailing Address - Street 1:URB. COUNTRY CLUB AVE. SANCHEZ VILELLA #819
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-6121
Mailing Address - Country:US
Mailing Address - Phone:787-762-3200
Mailing Address - Fax:
Practice Address - Street 1:URB. COUNTRY CLUB AVE. SANCHEZ VILELLA #819
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-6121
Practice Address - Country:US
Practice Address - Phone:787-762-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-F-10783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy