Provider Demographics
NPI:1750500302
Name:FARMACIA MEDIANIA INC
Entity Type:Organization
Organization Name:FARMACIA MEDIANIA INC
Other - Org Name:FARMACIA MEDIANIA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-876-1927
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:LOIZA
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0528
Mailing Address - Country:US
Mailing Address - Phone:787-876-1927
Mailing Address - Fax:787-256-2777
Practice Address - Street 1:CARR 187 KM 7.0
Practice Address - Street 2:MEDIANIA ALTA
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-1927
Practice Address - Fax:787-256-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13-F-06293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4014433OtherNCPDP