Provider Demographics
NPI:1730322173
Name:DROMAYOR BOGOTA S.A
Entity Type:Organization
Organization Name:DROMAYOR BOGOTA S.A
Other - Org Name:SUPERPHARMA DRUG STORE
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANNAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:FARAFAN
Authorized Official - Last Name:PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-294-8787
Mailing Address - Street 1:CLL 18 NO 68 D 72
Mailing Address - Street 2:
Mailing Address - City:BOGOTA D.C
Mailing Address - State:CUNDINAMARCA
Mailing Address - Zip Code:11001000
Mailing Address - Country:CO
Mailing Address - Phone:571-294-8787
Mailing Address - Fax:571-294-8787
Practice Address - Street 1:CALLE 18 NO 68 D 72
Practice Address - Street 2:
Practice Address - City:BOGOTA D.C
Practice Address - State:CUNDINAMARCA
Practice Address - Zip Code:11001000
Practice Address - Country:CO
Practice Address - Phone:571-294-8787
Practice Address - Fax:571-294-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management