Provider Demographics
NPI:1891706446
Name:SUPER FARMACIA LUVAMAR INC
Entity Type:Organization
Organization Name:SUPER FARMACIA LUVAMAR INC
Other - Org Name:SUPER FARMACIA LUVAMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCREA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-380-1004
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0518
Mailing Address - Country:US
Mailing Address - Phone:787-826-9292
Mailing Address - Fax:787-826-9393
Practice Address - Street 1:EDIF.PASEO DEL RIO CARR. 405 KM. 0.9
Practice Address - Street 2:BO. CARRERAS
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-9292
Practice Address - Fax:787-826-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16F23783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087438OtherPK