Provider Demographics
NPI:1356408389
Name:FARMACIA NUEVO CONCEPTO
Entity type:Organization
Organization Name:FARMACIA NUEVO CONCEPTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AWILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOLLANO CHICO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-895-3060
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0957
Mailing Address - Country:US
Mailing Address - Phone:787-895-3060
Mailing Address - Fax:787-895-1804
Practice Address - Street 1:157 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0957
Practice Address - Country:US
Practice Address - Phone:787-895-3060
Practice Address - Fax:787-895-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X, 332BP3500X, 332B00000X
PR07F0004333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4015245OtherNABP
PR1264210001Medicare NSC