Provider Demographics
NPI:1336386960
Name:FARMACIA SANTA JUANA INC
Entity Type:Organization
Organization Name:FARMACIA SANTA JUANA INC
Other - Org Name:FARMACIA LAS CATALINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-414-9738
Mailing Address - Street 1:27 CALLE REGINA MEDINA CONDOMINIO ATRIUM PARK APT B807
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:939-339-7353
Mailing Address - Fax:787-653-0939
Practice Address - Street 1:W PLAZA MALL LOCAL A BO PUEBLO CARR. 156
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-3503
Practice Address - Fax:787-745-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 1835P2201X
PR11-F-2694333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038529600Medicaid