Provider Demographics
NPI:1659340628
Name:SANTURCE PHARMACEUTICAL CORP
Entity Type:Organization
Organization Name:SANTURCE PHARMACEUTICAL CORP
Other - Org Name:FARMACIA SPC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GALINDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-782-7113
Mailing Address - Street 1:547 CALLE ESCORIAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4706
Mailing Address - Country:US
Mailing Address - Phone:787-782-7113
Mailing Address - Fax:787-774-1479
Practice Address - Street 1:547 CALLE ESCORIAL
Practice Address - Street 2:CAPARRA HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4706
Practice Address - Country:US
Practice Address - Phone:787-782-7113
Practice Address - Fax:787-774-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05-P-2123332BX2000X
PR07-F-2129333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1302230001Medicare NSC