Provider Demographics
NPI:1639236946
Name:FARMACIA MEDINA 5 INC
Entity Type:Organization
Organization Name:FARMACIA MEDINA 5 INC
Other - Org Name:FARMACIA MEDINA #5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-763-0255
Mailing Address - Street 1:BO SABANA LLANA
Mailing Address - Street 2:486 CALLE DE DIEGO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3141
Mailing Address - Country:US
Mailing Address - Phone:787-763-0255
Mailing Address - Fax:787-763-0360
Practice Address - Street 1:BO SABANA LLANA
Practice Address - Street 2:486 CALLE DE DIEGO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3141
Practice Address - Country:US
Practice Address - Phone:787-763-0255
Practice Address - Fax:787-763-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-30483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136408OtherPK