Provider Demographics
NPI:1205806643
Name:FARMACIA DEL CENTRO
Entity type:Organization
Organization Name:FARMACIA DEL CENTRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAITOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-817-3144
Mailing Address - Street 1:PO BOX 9091
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9091
Mailing Address - Country:US
Mailing Address - Phone:787-879-1641
Mailing Address - Fax:787-817-4918
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URB. VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-879-1641
Practice Address - Fax:787-817-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11F1282332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1290070001Medicare NSC