Provider Demographics
NPI:1700460524
Name:PREMIUM PHARMACY 2
Entity Type:Organization
Organization Name:PREMIUM PHARMACY 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-444-4908
Mailing Address - Street 1:LAGUNA GARDENS SHOPPING CENTER
Mailing Address - Street 2:SUITE 115-A
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-791-2065
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL EL MAESTRO CALLE SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:HOSPITAL EL MAESTRO, CALLE SERGIO CUEVAS BUSTAMANTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-791-2065
Practice Address - Fax:787-791-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy