Provider Demographics
NPI:1679064844
Name:SUPER FARMACIA NUEVA SABANA HOYOS, INC.
Entity Type:Organization
Organization Name:SUPER FARMACIA NUEVA SABANA HOYOS, INC.
Other - Org Name:PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MENCIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IGUINA
Authorized Official - Suffix:
Authorized Official - Credentials:FARMACY TECHNIC
Authorized Official - Phone:787-299-9888
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0223
Mailing Address - Country:US
Mailing Address - Phone:787-680-1298
Mailing Address - Fax:787-680-1299
Practice Address - Street 1:CARR 639 KM 1.4 SECTOR CANDELARIA
Practice Address - Street 2:BO SABANA HOYOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-680-1298
Practice Address - Fax:787-680-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20-F-35493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid