Provider Demographics
NPI:1952446825
Name:FARMACIA SAN RAFAEL SANTURCE, INC
Entity Type:Organization
Organization Name:FARMACIA SAN RAFAEL SANTURCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:DIAZ REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PH T
Authorized Official - Phone:787-724-3333
Mailing Address - Street 1:851 CALLE LAFAYETTE
Mailing Address - Street 2:PDA 20
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2627
Mailing Address - Country:US
Mailing Address - Phone:787-724-3333
Mailing Address - Fax:787-721-4165
Practice Address - Street 1:851 CALLE LAFAYETTE
Practice Address - Street 2:PDA 20
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2627
Practice Address - Country:US
Practice Address - Phone:787-724-3333
Practice Address - Fax:787-721-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17-F-22983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17-F-2298OtherSTATE LICENSE
PRBF9443665OtherDEA REGISTRATION