Provider Demographics
NPI:1134794175
Name:LA BOTICA: FARMACIA Y ALGO MAS...LLC
Entity type:Organization
Organization Name:LA BOTICA: FARMACIA Y ALGO MAS...LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:YAMILE
Authorized Official - Last Name:LIZASUAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM TECH
Authorized Official - Phone:787-513-8537
Mailing Address - Street 1:1513 CALLE CAVALIERI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6122
Mailing Address - Country:US
Mailing Address - Phone:787-513-8537
Mailing Address - Fax:
Practice Address - Street 1:CARR NO 20 KM 9.2
Practice Address - Street 2:BO CAMARONES
Practice Address - City:GUAYNABO, PR
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:178-751-3853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7877318487OtherPHARMACY