Provider Demographics
NPI:1821059411
Name:JORGE W MUNOZ MARCIAL
Entity Type:Organization
Organization Name:JORGE W MUNOZ MARCIAL
Other - Org Name:FARMACIA GUANIQUENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-821-6323
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0744
Mailing Address - Country:US
Mailing Address - Phone:787-821-6323
Mailing Address - Fax:787-821-0486
Practice Address - Street 1:24 CALLE SAN MIGUEL
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2611
Practice Address - Country:US
Practice Address - Phone:787-821-6323
Practice Address - Fax:787-821-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F2273333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3954530002Medicare ID - Type UnspecifiedPROVIDER NUMBER