Provider Demographics
NPI:1013067339
Name:FARMACIA UNIVERSAL EJD INC
Entity type:Organization
Organization Name:FARMACIA UNIVERSAL EJD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-743-6849
Mailing Address - Street 1:80 AVE L MUNOZ MARIN
Mailing Address - Street 2:STE 105
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4080
Mailing Address - Country:US
Mailing Address - Phone:787-743-6849
Mailing Address - Fax:787-743-6849
Practice Address - Street 1:80 AVE L MUNOZ MARIN
Practice Address - Street 2:STE 105
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4080
Practice Address - Country:US
Practice Address - Phone:787-743-6849
Practice Address - Fax:787-743-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR14F25993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4021793OtherNCPDP PROVIDER IDENTIFICATION NUMBER