Provider Demographics
NPI:1023232055
Name:HOSPITAL DE LA CONCEPCION FARMACIA
Entity type:Organization
Organization Name:HOSPITAL DE LA CONCEPCION FARMACIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALMODOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-892-1860
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0285
Mailing Address - Country:US
Mailing Address - Phone:787-892-1860
Mailing Address - Fax:787-264-7908
Practice Address - Street 1:ROAD # 2 KM 173.4
Practice Address - Street 2:BO CAIN BAJO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:787-264-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F21703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4018289OtherNABP NUMBER