Provider Demographics
NPI:1760916472
Name:IVAMIK LLC
Entity Type:Organization
Organization Name:IVAMIK LLC
Other - Org Name:FARMACIA VAZQUEZ #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-738-1444
Mailing Address - Street 1:PO BOX 370627
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-0627
Mailing Address - Country:US
Mailing Address - Phone:787-738-1444
Mailing Address - Fax:787-263-8030
Practice Address - Street 1:CARR 1 KM 56.5 MARGINAL
Practice Address - Street 2:BO MONTELLANOS
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737
Practice Address - Country:US
Practice Address - Phone:787-738-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19-F-34883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy