Provider Demographics
NPI:1972644060
Name:FARMACIA PONTEZUELA 24 LLC
Entity Type:Organization
Organization Name:FARMACIA PONTEZUELA 24 LLC
Other - Org Name:FARMACIA WATTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-649-7450
Mailing Address - Street 1:PO BOX 29619
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0619
Mailing Address - Country:US
Mailing Address - Phone:787-876-2174
Mailing Address - Fax:
Practice Address - Street 1:CALLE AUTONOMIA
Practice Address - Street 2:STE 72
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3249
Practice Address - Country:US
Practice Address - Phone:787-876-2174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17-F-33323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156146OtherPK