Provider Demographics
NPI:1669507687
Name:FARMACIA COOPERATIVA AGUADA
Entity Type:Organization
Organization Name:FARMACIA COOPERATIVA AGUADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-868-2115
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-868-9495
Mailing Address - Fax:787-252-3155
Practice Address - Street 1:BARRIO ASOMANTE
Practice Address - Street 2:CARR 115 KM 248
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-9495
Practice Address - Fax:787-252-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1323500001Medicare ID - Type Unspecified