Provider Demographics
NPI:1881681047
Name:SUPER FARMACIA REBECA
Entity Type:Organization
Organization Name:SUPER FARMACIA REBECA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULA
Authorized Official - Suffix:
Authorized Official - Credentials:BSPH/MSPH
Authorized Official - Phone:787-872-2410
Mailing Address - Street 1:80 AVE NOEL ESTRADA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3102
Mailing Address - Country:US
Mailing Address - Phone:787-872-2410
Mailing Address - Fax:787-830-6262
Practice Address - Street 1:80 AVE NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3102
Practice Address - Country:US
Practice Address - Phone:787-872-2410
Practice Address - Fax:787-830-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1962302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
4573010001Medicare ID - Type Unspecified