Provider Demographics
NPI:1710035803
Name:FARMACIA EL JUNCO
Entity Type:Organization
Organization Name:FARMACIA EL JUNCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:787-816-5921
Mailing Address - Street 1:HC 2 BOX 35127
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9317
Mailing Address - Country:US
Mailing Address - Phone:787-816-5921
Mailing Address - Fax:787-816-5837
Practice Address - Street 1:ROAD 651 KM 2.5 SECTOR EL JUNCO BO HATO ARRIBA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-5921
Practice Address - Fax:787-816-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08-F-23983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy