Provider Demographics
NPI:1609887272
Name:FARMACIA VICTORIA INC
Entity Type:Organization
Organization Name:FARMACIA VICTORIA INC
Other - Org Name:FARMACIA VICTORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NIMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:787-878-6665
Mailing Address - Street 1:HC 6 BOX 94610
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9654
Mailing Address - Country:US
Mailing Address - Phone:787-878-6665
Mailing Address - Fax:787-650-3976
Practice Address - Street 1:CARR. 129 KM 5.0
Practice Address - Street 2:BO. HATO ARRIBA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9613
Practice Address - Country:US
Practice Address - Phone:787-878-6665
Practice Address - Fax:787-650-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-28613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087519OtherPK
2087519OtherPK