Provider Demographics
NPI:1730477746
Name:FARMACIA SHALOM, INC.
Entity Type:Organization
Organization Name:FARMACIA SHALOM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MRS
Authorized Official - Phone:787-895-0914
Mailing Address - Street 1:CARR # 2 KM 101.6
Mailing Address - Street 2:TERRANOVA WARD
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0000
Mailing Address - Country:US
Mailing Address - Phone:787-895-0914
Mailing Address - Fax:787-895-6942
Practice Address - Street 1:CARRETERA NUMERO 2 KM 101.6
Practice Address - Street 2:BARRIO TERRANOVA
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0000
Practice Address - Country:US
Practice Address - Phone:787-895-0914
Practice Address - Fax:787-895-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11-F-27773336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy