Provider Demographics
NPI:1396104386
Name:SD PHARMACY INC
Entity type:Organization
Organization Name:SD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PAOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-651-1920
Mailing Address - Street 1:PO BOX 801014
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1014
Mailing Address - Country:US
Mailing Address - Phone:939-292-3580
Mailing Address - Fax:787-651-6130
Practice Address - Street 1:CARRETERA 510 KM 6.5
Practice Address - Street 2:BO AMUELAS
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-651-6920
Practice Address - Fax:787-651-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR18-F-33453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158213OtherPK