Provider Demographics
NPI:1689752941
Name:SUPER FARMACIA TRIPLE R, INC.
Entity Type:Organization
Organization Name:SUPER FARMACIA TRIPLE R, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-855-6033
Mailing Address - Street 1:4020, CARR #2
Mailing Address - Street 2:SUITE 28, PLAZA JARDINES
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-855-6033
Mailing Address - Fax:787-855-6033
Practice Address - Street 1:4020 CARR 2
Practice Address - Street 2:SUITE 28, PLAZA JARDINES
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-6141
Practice Address - Country:US
Practice Address - Phone:787-855-6033
Practice Address - Fax:787-855-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11-F-12063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy