Provider Demographics
NPI:1013061662
Name:FARMACIA LAS LOMAS
Entity Type:Organization
Organization Name:FARMACIA LAS LOMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANUCHI HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-783-3755
Mailing Address - Street 1:829 AVE SAN PATRICIO STE 1
Mailing Address - Street 2:LAS LOMAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1313
Mailing Address - Country:US
Mailing Address - Phone:787-783-3755
Mailing Address - Fax:787-792-0466
Practice Address - Street 1:829 AVE SAN PATRICIO STE 1
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1313
Practice Address - Country:US
Practice Address - Phone:787-783-3755
Practice Address - Fax:787-792-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-01463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4016223OtherNABP