Provider Demographics
NPI:1952454423
Name:SUPER FARMAACIA IDEAL
Entity Type:Organization
Organization Name:SUPER FARMAACIA IDEAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YARIMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-752-9120
Mailing Address - Street 1:PO BOX 29003
Mailing Address - Street 2:65 INFANTERIA STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0003
Mailing Address - Country:US
Mailing Address - Phone:787-752-9120
Mailing Address - Fax:787-776-1148
Practice Address - Street 1:CENTRO COMERCIAL EL COMANDANTE
Practice Address - Street 2:AVE. 65 INF. ESQ. SAN MARCOS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-752-9120
Practice Address - Fax:787-776-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-21233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy