Provider Demographics
NPI:1760527006
Name:SUPER FARMACIA DEL PUEBLO INC
Entity Type:Organization
Organization Name:SUPER FARMACIA DEL PUEBLO INC
Other - Org Name:SUPER FARMACIA LA MONSERRATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-877-2405
Mailing Address - Street 1:235 BARBOSA ST
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-2405
Mailing Address - Fax:787-877-8822
Practice Address - Street 1:235 BARBOSA ST
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-2405
Practice Address - Fax:787-877-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
PR17-F-19383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086162OtherPK