Provider Demographics
NPI:1760503825
Name:ELBA I. CHINEA
Entity Type:Organization
Organization Name:ELBA I. CHINEA
Other - Org Name:SUPER FARMACIA CENTRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:CHINEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-797-5555
Mailing Address - Street 1:RR 14 BOX 5333
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-797-5555
Mailing Address - Fax:787-797-5555
Practice Address - Street 1:CARR 167 # KM11.0
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-797-5555
Practice Address - Fax:787-797-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4002084OtherNBAP