Provider Demographics
NPI:1770628455
Name:SUPER FARMACIA SANTA ANA
Entity Type:Organization
Organization Name:SUPER FARMACIA SANTA ANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-0593
Mailing Address - Street 1:76A CALLE JILGUERO
Mailing Address - Street 2:PARCELAS CARMEN
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-5810
Mailing Address - Country:US
Mailing Address - Phone:787-270-0593
Mailing Address - Fax:787-270-2503
Practice Address - Street 1:CARRETERA # 2 KM 29.1
Practice Address - Street 2:PARCELAS CARMEN
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-0593
Practice Address - Fax:787-270-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-13473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy