Provider Demographics
NPI:1134269111
Name:FARMACIA CUQUIMAR, INC.
Entity type:Organization
Organization Name:FARMACIA CUQUIMAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE Y REGENTE
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-255-6551
Mailing Address - Street 1:P.O. BOX 362
Mailing Address - Street 2:CARR 101 KM 16.2 LAS ARENAS BOQUERON
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-255-6551
Mailing Address - Fax:787-255-6551
Practice Address - Street 1:STREET 101 KM 16.2
Practice Address - Street 2:LAS ARENAS BOQUERON
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622
Practice Address - Country:US
Practice Address - Phone:787-255-6551
Practice Address - Fax:787-255-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09F21843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5580390001Medicare NSC