Provider Demographics
NPI:1336480177
Name:FARMACIA DOMINGUITO INC.
Entity Type:Organization
Organization Name:FARMACIA DOMINGUITO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-399-9900
Mailing Address - Street 1:HC 2 BOX 16815
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9394
Mailing Address - Country:US
Mailing Address - Phone:787-399-9900
Mailing Address - Fax:787-650-4868
Practice Address - Street 1:HC 2 BOX 16815
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9394
Practice Address - Country:US
Practice Address - Phone:787-691-5578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006921333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy