Provider Demographics
NPI:1699177261
Name:DAMAR OF PUERTO RICO SERVICES INC
Entity Type:Organization
Organization Name:DAMAR OF PUERTO RICO SERVICES INC
Other - Org Name:FARMACIA CDT DR. ENRIQUE KOPPISCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:786-547-3240
Mailing Address - Street 1:PO BOX 25130
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-5130
Mailing Address - Country:US
Mailing Address - Phone:787-294-0076
Mailing Address - Fax:
Practice Address - Street 1:ESQ. BARBOSA #404
Practice Address - Street 2:CALLE SICILIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-294-0076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-31583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148034OtherPK