Provider Demographics
NPI:1336183649
Name:FARMACIA PAJUIL LLC
Entity Type:Organization
Organization Name:FARMACIA PAJUIL LLC
Other - Org Name:FARMACIA PAJUIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-900-5929
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1323
Mailing Address - Country:US
Mailing Address - Phone:787-820-1972
Mailing Address - Fax:787-680-0188
Practice Address - Street 1:CARR 490 KM 3 2 B CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-1972
Practice Address - Fax:787-898-6239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F12153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086078OtherPK
PR4019875Medicaid