Provider Demographics
NPI:1619029204
Name:FARMACIA NUEVA
Entity Type:Organization
Organization Name:FARMACIA NUEVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-732-4799
Mailing Address - Street 1:PO BOX 1202
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-1202
Mailing Address - Country:US
Mailing Address - Phone:787-732-4799
Mailing Address - Fax:787-732-4799
Practice Address - Street 1:CARR. 156 KM 49.0
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-1202
Practice Address - Country:US
Practice Address - Phone:787-732-4799
Practice Address - Fax:787-732-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-13813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07-F-1381OtherPHARMACY LIC.
PRDF-02035-4OtherASSMCA CERTIFICATE
PRDF-02035-4OtherASSMCA CERTIFICATE
PRBF3954876OtherDEA CERTIFICATE