Provider Demographics
NPI:1790380954
Name:PARKMEDIA PHARMACY LLC
Entity Type:Organization
Organization Name:PARKMEDIA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-620-8181
Mailing Address - Street 1:CARR #2 KM 11.6
Mailing Address - Street 2:BAYAMON MEDICAL PLAZA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 11.6
Practice Address - Street 2:BAYAMON MEDICAL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-786-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy