Provider Demographics
NPI:1710173448
Name:MEDICOS PHARMACY & LABORATORY
Entity Type:Organization
Organization Name:MEDICOS PHARMACY & LABORATORY
Other - Org Name:FARMACIA MPL CDT DR OLIVERA GUERRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-707-1983
Mailing Address - Street 1:PO BOX 51991
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1991
Mailing Address - Country:US
Mailing Address - Phone:787-707-1983
Mailing Address - Fax:
Practice Address - Street 1:CALLE 8 ESQUINA 45 PARA LAS FALU
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950
Practice Address - Country:US
Practice Address - Phone:787-771-3000
Practice Address - Fax:787-706-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10F26323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4026438OtherNCPDP PROVIDER IDENTIFICATION NUMBER