Provider Demographics
NPI:1790830958
Name:FARMACIA SAN JUSTO INC.
Entity Type:Organization
Organization Name:FARMACIA SAN JUSTO INC.
Other - Org Name:FARMACIA SAN JUSTO & MEDICAL EQUIPMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-755-1085
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:SAINT JUST STATION
Mailing Address - City:SAINT JUST
Mailing Address - State:PR
Mailing Address - Zip Code:00978-1347
Mailing Address - Country:US
Mailing Address - Phone:787-755-1085
Mailing Address - Fax:866-350-4010
Practice Address - Street 1:CARRETERA 181, INTERSECCION CARRETERA 848,
Practice Address - Street 2:CENTRO 4 PLAZA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00978
Practice Address - Country:US
Practice Address - Phone:787-755-1085
Practice Address - Fax:866-350-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
PR07-F-05973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4012251OtherNABP
PR4539600001Medicare NSC