Provider Demographics
NPI:1730122110
Name:SUPERTIENDA FAMILIAR INC
Entity Type:Organization
Organization Name:SUPERTIENDA FAMILIAR INC
Other - Org Name:FARMACIA LUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FERNANDEZ
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-508-9306
Mailing Address - Street 1:PO BOX 79514
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9514
Mailing Address - Country:US
Mailing Address - Phone:787-722-0335
Mailing Address - Fax:787-725-8292
Practice Address - Street 1:SAN FRANCISCO STE 255
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1724
Practice Address - Country:US
Practice Address - Phone:787-722-0335
Practice Address - Fax:787-725-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-33023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085367OtherPK