Provider Demographics
NPI:1255456430
Name:B52 RX GROUP LLC
Entity type:Organization
Organization Name:B52 RX GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-899-1693
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0215
Mailing Address - Country:US
Mailing Address - Phone:787-899-1693
Mailing Address - Fax:787-899-7770
Practice Address - Street 1:CALLE 65 INFANTERIA
Practice Address - Street 2:# 13 C
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-1693
Practice Address - Fax:787-899-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F31533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144852OtherPK
DCAF4207595OtherDEPT OF JUSTICE DEA
4004191OtherNABP NCPDP
1148600001Medicare ID - Type UnspecifiedCMS