Provider Demographics
NPI:1922337468
Name:MUNICIPALITY OF SAN JUAN PR
Entity Type:Organization
Organization Name:MUNICIPALITY OF SAN JUAN PR
Other - Org Name:FARMACIA COMPLEJO MEDICO SOCIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGENT PHARMACYST
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:COSME SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-767-7676
Mailing Address - Street 1:AVENIDA 65 DE INFANTERIA KM.3.4 BO. SABANA LLANA RIO PI
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-767-7676
Mailing Address - Fax:787-765-1340
Practice Address - Street 1:AVENIDA 65 DE INFANTERIA KM.3.4 BO. SABANA LLANA RIO PI
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-767-7676
Practice Address - Fax:787-765-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11F00903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4027086OtherNCPDP PROVIDER IDENTIFICATION NUMBER