Provider Demographics
NPI:1609116508
Name:DAMAR OF PUERTO RICO SERVICES INC
Entity Type:Organization
Organization Name:DAMAR OF PUERTO RICO SERVICES INC
Other - Org Name:FARMACIA ACADEMICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHIQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR IN PHARM
Authorized Official - Phone:787-396-8165
Mailing Address - Street 1:P.O. BOX 25130
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-5130
Mailing Address - Country:US
Mailing Address - Phone:786-547-3240
Mailing Address - Fax:
Practice Address - Street 1:URB. INDUSTRIAL REPARADA
Practice Address - Street 2:LOTE A-2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-259-3946
Practice Address - Fax:787-841-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR17-F-31133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139152OtherPK