Provider Demographics
NPI:1841412343
Name:PUERTO RICO PHARMACY CORP.
Entity Type:Organization
Organization Name:PUERTO RICO PHARMACY CORP.
Other - Org Name:FARMACIAS PUERTO RICO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-785-0767
Mailing Address - Street 1:CALLE 37 AS 52 SANTA JUANITA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-785-0767
Mailing Address - Fax:787-995-0327
Practice Address - Street 1:AVE. LOMAS VERDES, EDIF. UNIVERSDAD PHOENIX,
Practice Address - Street 2:CARRETERA 177, KM. 2.0
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-272-4998
Practice Address - Fax:787-272-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5596330001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5596330001Medicare ID - Type Unspecified