Provider Demographics
NPI:1629395090
Name:WILMET I MILLAN CAMACHO
Entity Type:Organization
Organization Name:WILMET I MILLAN CAMACHO
Other - Org Name:FARMACIA ROSALINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILMET
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-397-2161
Mailing Address - Street 1:PO BO BOX 8364
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8364
Mailing Address - Country:US
Mailing Address - Phone:787-850-2040
Mailing Address - Fax:787-850-2232
Practice Address - Street 1:344 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3228
Practice Address - Country:US
Practice Address - Phone:787-850-2040
Practice Address - Fax:787-850-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR12F28373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4027339OtherNCPDP PROVIDER IDENTIFICATION NUMBER