Provider Demographics
NPI:1659454684
Name:ASOCIACION DE PENSIONADOS DEL GOBIERNO DE PR, INC
Entity Type:Organization
Organization Name:ASOCIACION DE PENSIONADOS DEL GOBIERNO DE PR, INC
Other - Org Name:FARMACIA LA CASA DEL PENSIONADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAVELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-222-3211
Mailing Address - Street 1:100 AVE.HERNAN CORTES SUITE 5, PBM 8
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977
Mailing Address - Country:US
Mailing Address - Phone:787-250-6203
Mailing Address - Fax:787-765-1581
Practice Address - Street 1:115 URB EL VEDADO, CALLE RODRIGO DE TRIANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3207
Practice Address - Country:US
Practice Address - Phone:787-250-6203
Practice Address - Fax:787-765-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05-F-1374183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4019647OtherNCPDP