Provider Demographics
NPI:1639101231
Name:FSA RX LLC
Entity Type:Organization
Organization Name:FSA RX LLC
Other - Org Name:FSA RX LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-738-3010
Mailing Address - Street 1:PO BOX 370523
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-0523
Mailing Address - Country:US
Mailing Address - Phone:787-738-3010
Mailing Address - Fax:787-738-6145
Practice Address - Street 1:4 AVE MUNOZ RIVERA N # 4
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3715
Practice Address - Country:US
Practice Address - Phone:787-738-3010
Practice Address - Fax:787-738-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F04843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2082896OtherPK