Provider Demographics
NPI:1629505318
Name:FARMACIA LA FE REFORMADA INC
Entity Type:Organization
Organization Name:FARMACIA LA FE REFORMADA INC
Other - Org Name:FARMACIA LA FE #5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-479-7214
Mailing Address - Street 1:108 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00730
Mailing Address - Country:UM
Mailing Address - Phone:787-569-8700
Mailing Address - Fax:787-842-4671
Practice Address - Street 1:THE NEW SHOPPING CENTER
Practice Address - Street 2:421 MUNOZ RIVERA ESQUINA FERROCARRIL
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00733
Practice Address - Country:UM
Practice Address - Phone:787-569-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19-F-3490305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR19-F-3490OtherSTATE LICENCE