Provider Demographics
NPI:1699807560
Name:SUPER FARMACIA LA ECONOMIA
Entity Type:Organization
Organization Name:SUPER FARMACIA LA ECONOMIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-786-9610
Mailing Address - Street 1:URB. SIERRA BAYAMON
Mailing Address - Street 2:BLOQUE 28 NO. 20 AVE. GILBERTO CONCEPCION DE GRACIA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4329
Mailing Address - Country:US
Mailing Address - Phone:787-786-9610
Mailing Address - Fax:787-786-9610
Practice Address - Street 1:URB. SIERRA BAYAMON
Practice Address - Street 2:BLOQUE 28 NO. 20 AVE. GILBERTO CONCEPCION DE GRACIA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4329
Practice Address - Country:US
Practice Address - Phone:787-786-9610
Practice Address - Fax:787-786-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-16393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy