Provider Demographics
NPI:1952653776
Name:FARMACIA SAGRADO, INC.
Entity Type:Organization
Organization Name:FARMACIA SAGRADO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILIANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-448-5914
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0539
Mailing Address - Country:US
Mailing Address - Phone:787-649-9249
Mailing Address - Fax:787-873-7373
Practice Address - Street 1:CALLE ANGEL G. MARTINEZ 3
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-649-9249
Practice Address - Fax:787-873-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy