Provider Demographics
NPI:1922701135
Name:FARMACIA CPTET ARECIBO
Entity Type:Organization
Organization Name:FARMACIA CPTET ARECIBO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:JOASH
Authorized Official - Last Name:MAYSONET FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-765-2929
Mailing Address - Street 1:627 AVE SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3666
Mailing Address - Country:US
Mailing Address - Phone:787-765-2929
Mailing Address - Fax:
Practice Address - Street 1:627 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3666
Practice Address - Country:US
Practice Address - Phone:787-765-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTAMENTO DE SALUD OFICIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-24
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy