Provider Demographics
NPI:1396702825
Name:FARMACIA MARBELLA
Entity type:Organization
Organization Name:FARMACIA MARBELLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-1380
Mailing Address - Street 1:PO BOX 5138
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:P.R.
Mailing Address - Zip Code:00605
Mailing Address - Country:UM
Mailing Address - Phone:787-891-1380
Mailing Address - Fax:787-891-2485
Practice Address - Street 1:CARR107 KM.1.1 BO. BORINQUEN
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-5138
Practice Address - Country:US
Practice Address - Phone:787-891-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1210450001Medicare ID - Type Unspecified
1210450001Medicare NSC