Provider Demographics
NPI:1851882898
Name:LATITUD 18 NORTE LLC
Entity Type:Organization
Organization Name:LATITUD 18 NORTE LLC
Other - Org Name:MI FARMACIA DOMINGUEZ Y MUCHO MAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENIGNO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-600-0283
Mailing Address - Street 1:GRAN VISTA I
Mailing Address - Street 2:51 CALLE LA CEIBA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-600-0283
Mailing Address - Fax:
Practice Address - Street 1:CARR 796 KM 0.3 BO RIO CANAS
Practice Address - Street 2:SECTOR LA GUASABARA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-204-9030
Practice Address - Fax:939-204-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20-F35533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy