Provider Demographics
NPI:1295932333
Name:PHARMAMED PHARMACY INC
Entity type:Organization
Organization Name:PHARMAMED PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-846-7100
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0627
Mailing Address - Country:US
Mailing Address - Phone:787-846-7100
Mailing Address - Fax:787-846-7101
Practice Address - Street 1:4 CARR 140 # KM
Practice Address - Street 2:BO FLORIDA AFUERA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2756
Practice Address - Country:US
Practice Address - Phone:787-846-7100
Practice Address - Fax:787-846-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-30613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087563OtherPK