Provider Demographics
NPI:1205168853
Name:FARMACIA SHALOM INC
Entity type:Organization
Organization Name:FARMACIA SHALOM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DE LOS ANGELES
Authorized Official - Last Name:PAGAN LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-895-0914
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0903
Mailing Address - Country:US
Mailing Address - Phone:787-895-0914
Mailing Address - Fax:787-895-4999
Practice Address - Street 1:CARR 2 KM 101 6 MARGINAL DEL PARQUE
Practice Address - Street 2:TERRANOVA
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-0914
Practice Address - Fax:787-895-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11-F-27773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11-F-2777OtherPHARMACY SERVICES