Provider Demographics
NPI:1619194321
Name:FARMACIA ALICIA
Entity Type:Organization
Organization Name:FARMACIA ALICIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-726-0939
Mailing Address - Street 1:2203 AVE BORINQUEN
Mailing Address - Street 2:BARRIO OBRERO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-4416
Mailing Address - Country:US
Mailing Address - Phone:787-726-0939
Mailing Address - Fax:787-726-0939
Practice Address - Street 1:2203 AVE BORINQUEN
Practice Address - Street 2:BARRIO OBRERO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-4416
Practice Address - Country:US
Practice Address - Phone:787-726-0939
Practice Address - Fax:787-726-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07F1358OtherHEALTH DEPT.