Provider Demographics
NPI:1619281599
Name:ED S PHARMACY CORPORATION
Entity Type:Organization
Organization Name:ED S PHARMACY CORPORATION
Other - Org Name:ED'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-381-5471
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-1790
Mailing Address - Country:US
Mailing Address - Phone:787-255-0485
Mailing Address - Fax:787-255-0486
Practice Address - Street 1:RD 307
Practice Address - Street 2:KM 4.8
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622
Practice Address - Country:US
Practice Address - Phone:787-255-0485
Practice Address - Fax:787-255-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR12-F-28703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4027492OtherNCPDP PROVIDER IDENTIFICATION NUMBER