Provider Demographics
NPI:1609928902
Name:FARMACIA COOP CAMUY
Entity Type:Organization
Organization Name:FARMACIA COOP CAMUY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE EJECUTIVO
Authorized Official - Prefix:MR
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-872-2590
Mailing Address - Street 1:162 AVE MUNOZ RIVERA 162
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:787-262-2007
Mailing Address - Fax:787-898-1285
Practice Address - Street 1:162 AVE MUNOZ RIVERA E
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2632
Practice Address - Country:US
Practice Address - Phone:787-262-2007
Practice Address - Fax:787-898-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-13843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401978-6OtherNCPDP