Provider Demographics
NPI:1851575112
Name:FARMACIA DEJIREH CORP
Entity Type:Organization
Organization Name:FARMACIA DEJIREH CORP
Other - Org Name:FARMACIA DEJIREH CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-559-1137
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0548
Mailing Address - Country:US
Mailing Address - Phone:787-852-2828
Mailing Address - Fax:787-852-4622
Practice Address - Street 1:CARRETERA 3 URB BUZO
Practice Address - Street 2:443
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-2828
Practice Address - Fax:787-852-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15F25723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087590OtherPK