Provider Demographics
NPI:1598971962
Name:FARMACIA SANTA CRUZ
Entity Type:Organization
Organization Name:FARMACIA SANTA CRUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-292-6760
Mailing Address - Street 1:14 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-5914
Mailing Address - Country:US
Mailing Address - Phone:787-292-6760
Mailing Address - Fax:787-292-6760
Practice Address - Street 1:14 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5914
Practice Address - Country:US
Practice Address - Phone:787-292-6760
Practice Address - Fax:787-292-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08-F-1909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR08-F-1909OtherSTATE LICENCE