Provider Demographics
NPI:1588679104
Name:FARMACIA SAN FERNANDO INC
Entity Type:Organization
Organization Name:FARMACIA SAN FERNANDO INC
Other - Org Name:FARMACIA SAN FERNANDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PCHY TECH OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:PCHY TECH
Authorized Official - Phone:787-870-3475
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-0133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:STE 17
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-3475
Practice Address - Fax:787-870-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-01393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2083927OtherPK