Provider Demographics
NPI:1922152149
Name:FARMACIA NIEVES TA LLC
Entity Type:Organization
Organization Name:FARMACIA NIEVES TA LLC
Other - Org Name:FARMACIA NIEVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-797-7615
Mailing Address - Street 1:URB TOA ALTA HEIGHTS
Mailing Address - Street 2:CALLE 18 N 15 SUITE #1
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-797-7615
Mailing Address - Fax:787-799-7615
Practice Address - Street 1:URB TOA ALTA HEIGHTS
Practice Address - Street 2:AVENIDA PRINCIPAL N15
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-797-7615
Practice Address - Fax:787-799-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F-09693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084581OtherPK