Provider Demographics
NPI:1851499255
Name:SUPER FARMACIA DERKES INC
Entity Type:Organization
Organization Name:SUPER FARMACIA DERKES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM D
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-864-2516
Mailing Address - Street 1:PO BOX 2133
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2133
Mailing Address - Country:US
Mailing Address - Phone:787-864-2112
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE DERKES E
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4936
Practice Address - Country:US
Practice Address - Phone:787-864-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRBF3104724333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4018619OtherNABP