Provider Demographics
NPI:1639309545
Name:FARMACIA LA ROSA DE SARON INC
Entity Type:Organization
Organization Name:FARMACIA LA ROSA DE SARON INC
Other - Org Name:SUPER FARMACIA VILLA TOLEDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-226-1770
Mailing Address - Street 1:132 CALLE UMBRAL
Mailing Address - Street 2:URB VILLA TOLEDO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9689
Mailing Address - Country:US
Mailing Address - Phone:787-817-4747
Mailing Address - Fax:787-817-4646
Practice Address - Street 1:132 CALLE UMBRAL
Practice Address - Street 2:VILLA TOLEDO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9689
Practice Address - Country:US
Practice Address - Phone:787-817-4747
Practice Address - Fax:787-817-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0004X
PR17-F-27443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120882OtherPK