Provider Demographics
NPI:1639269699
Name:PRODUCTOS MEDICOS INC
Entity Type:Organization
Organization Name:PRODUCTOS MEDICOS INC
Other - Org Name:FARMACIA SAN CARLOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUPITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-726-6005
Mailing Address - Street 1:301 CALLE TAPIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-4215
Mailing Address - Country:US
Mailing Address - Phone:787-726-6005
Mailing Address - Fax:787-727-3537
Practice Address - Street 1:301 CALLE TAPIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-4215
Practice Address - Country:US
Practice Address - Phone:787-726-6005
Practice Address - Fax:787-727-3537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
PR07F00763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4015978OtherNCPDP PROVIDER IDENTIFICATION NUMBER