Provider Demographics
NPI:1205930617
Name:FARMACIA EXPRESO
Entity type:Organization
Organization Name:FARMACIA EXPRESO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-871-3105
Mailing Address - Street 1:500 CARR 149
Mailing Address - Street 2:STE 01
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9662
Mailing Address - Country:US
Mailing Address - Phone:787-871-3105
Mailing Address - Fax:787-871-3122
Practice Address - Street 1:CARR 149 KM 9 8
Practice Address - Street 2:BO HATO VIEJO SECTOR CAMPAMENTO
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9661
Practice Address - Country:US
Practice Address - Phone:787-871-3105
Practice Address - Fax:787-871-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
PR17F2920333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085936OtherPK