Provider Demographics
NPI:1851536833
Name:MAYAGUEZ CENTER DRUGSTORE INC
Entity Type:Organization
Organization Name:MAYAGUEZ CENTER DRUGSTORE INC
Other - Org Name:MAYAGUEZ CENTER DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-629-7709
Mailing Address - Street 1:7 MENDEZ VIGO W
Mailing Address - Street 2:STE 4
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-6668
Mailing Address - Country:US
Mailing Address - Phone:787-833-0277
Mailing Address - Fax:787-834-5925
Practice Address - Street 1:7 MENDEZ VIGO W
Practice Address - Street 2:STE 4
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-6668
Practice Address - Country:US
Practice Address - Phone:787-833-0277
Practice Address - Fax:787-834-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10F26833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4026589OtherNCPDP PROVIDER IDENTIFICATION NUMBER