Provider Demographics
NPI:1629296124
Name:FARMACIA MARBELLA INC
Entity Type:Organization
Organization Name:FARMACIA MARBELLA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-1380
Mailing Address - Street 1:BO BORINQUEN CARR 107
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-891-1380
Mailing Address - Fax:787-891-2485
Practice Address - Street 1:BO BORINQUEN CARR 107
Practice Address - Street 2:KM 1.1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-1380
Practice Address - Fax:787-891-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-2169332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSEGURO SOCIAL PATRONAL
PR=========OtherSEGURO SOCIAL PATRONAL