Provider Demographics
NPI:1639631435
Name:FARMACIA DE LA COMUNIDAD HOSPITAL MENONITA DE GUAYAMA
Entity Type:Organization
Organization Name:FARMACIA DE LA COMUNIDAD HOSPITAL MENONITA DE GUAYAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLIN ANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-374-6286
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:717-434-1715
Practice Address - Street 1:AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:URB LA HACIENDA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785-0011
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL MENONITA GUAYAMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4383339Medicaid