Provider Demographics
NPI:1649213026
Name:FARMACIA LA AURORA
Entity Type:Organization
Organization Name:FARMACIA LA AURORA
Other - Org Name:FARMACIA LA AURORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VIXMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-856-0023
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1305
Mailing Address - Country:US
Mailing Address - Phone:787-856-0023
Mailing Address - Fax:787-856-0085
Practice Address - Street 1:BO DIEGO HERNANDEZ CARR 128
Practice Address - Street 2:KM 3.3
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-0023
Practice Address - Fax:787-856-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19-F-15743336C0003X
PR17-F-15743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4020979Medicaid
2086264OtherPK
2086264OtherPK