Provider Demographics
NPI:1396877254
Name:FARMACIA DEL SUR
Entity type:Organization
Organization Name:FARMACIA DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-844-0098
Mailing Address - Street 1:19 CALLE COMERCIO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-5109
Mailing Address - Country:US
Mailing Address - Phone:787-844-0098
Mailing Address - Fax:787-290-0098
Practice Address - Street 1:19 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-5109
Practice Address - Country:US
Practice Address - Phone:787-844-0098
Practice Address - Fax:787-290-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08-F-2262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty