Provider Demographics
NPI:1598821506
Name:EDDIE A. HERNANDEZ ROSARIO
Entity Type:Organization
Organization Name:EDDIE A. HERNANDEZ ROSARIO
Other - Org Name:FARMACIA YAMILA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-735-2456
Mailing Address - Street 1:CALLE PEDRO ROSARIO #20
Mailing Address - Street 2:EDIFICIO AIBONITO PLAZA E-5
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2008
Mailing Address - Country:US
Mailing Address - Phone:787-735-2456
Mailing Address - Fax:787-735-2456
Practice Address - Street 1:20 CALLE PEDRO ROSARIO
Practice Address - Street 2:EDIFICIO AIBONITO PLAZA E-5
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3243
Practice Address - Country:US
Practice Address - Phone:787-735-2456
Practice Address - Fax:787-735-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-19123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy