Provider Demographics
NPI:1770678476
Name:QUIROZ LLC
Entity Type:Organization
Organization Name:QUIROZ LLC
Other - Org Name:FARMACIA CRISTINA 5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-786-1084
Mailing Address - Street 1:246 CALLE COMERIO
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5358
Mailing Address - Country:US
Mailing Address - Phone:787-785-3050
Mailing Address - Fax:787-787-3490
Practice Address - Street 1:246 CALLE COMERIO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5358
Practice Address - Country:US
Practice Address - Phone:787-785-3050
Practice Address - Fax:787-787-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1140578Medicaid
2150396OtherPK
PR07F003OtherSTATE PHARMACY LICENSE
PRAF4196487OtherDEA LICENSE NUMBER
PRDF002345OtherSTATE DISPENSING LICENSE