Provider Demographics
NPI:1942312954
Name:FARMACIA LORRAINE INC
Entity Type:Organization
Organization Name:FARMACIA LORRAINE INC
Other - Org Name:FARMACIA LORRAINE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS SANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-843-1838
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0581
Mailing Address - Country:US
Mailing Address - Phone:787-843-1838
Mailing Address - Fax:787-284-0838
Practice Address - Street 1:1681 PASEO VILLA FLORES
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2952
Practice Address - Country:US
Practice Address - Phone:787-843-1838
Practice Address - Fax:787-284-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17F16573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084728OtherPK
1275810001Medicare NSC