Provider Demographics
NPI:1659404697
Name:FARMACIA TRES HERMANOS INC
Entity Type:Organization
Organization Name:FARMACIA TRES HERMANOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:LEIDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-826-6453
Mailing Address - Street 1:CARR 401 TRES HERMANOS
Mailing Address - Street 2:BO PLAYA CARR 401 KM0.9
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0000
Mailing Address - Country:US
Mailing Address - Phone:787-826-6453
Mailing Address - Fax:787-826-6453
Practice Address - Street 1:CARR 401 TRES HERMANOS
Practice Address - Street 2:BO PLAYA CARR 401 KM0.9
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0000
Practice Address - Country:US
Practice Address - Phone:787-826-6453
Practice Address - Fax:787-826-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5631-063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4025323OtherNADP
PR157774OtherREGISTRO