Provider Demographics
NPI:1699005447
Name:LORAN CORP
Entity Type:Organization
Organization Name:LORAN CORP
Other - Org Name:FARMACIA GONZALEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-677-2000
Mailing Address - Street 1:1702 CALLE GARZA
Mailing Address - Street 2:URB BRISAS DEL PRADO
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2560
Mailing Address - Country:US
Mailing Address - Phone:787-845-2000
Mailing Address - Fax:787-845-2000
Practice Address - Street 1:BO JAUCA 2 SECTOR USERAS
Practice Address - Street 2:CARR 153 KM 3 HM 2
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-2000
Practice Address - Fax:787-845-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11-F-2761333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11-F-2761OtherPHARMACY LICENSE