Provider Demographics
NPI:1891819348
Name:FARMACIA DEL PUEBLO DE VEGA ALTA, INC.
Entity Type:Organization
Organization Name:FARMACIA DEL PUEBLO DE VEGA ALTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARRERO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-883-2065
Mailing Address - Street 1:300 AVE LA SIERRA APT 29
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4337
Mailing Address - Country:US
Mailing Address - Phone:787-883-2065
Mailing Address - Fax:787-623-8599
Practice Address - Street 1:CARR 2 KM 30. 1 BO. ESPINOZA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-2065
Practice Address - Fax:787-623-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08F2462183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4021894OtherNABP