Provider Demographics
NPI:1700961679
Name:FARMACIA CDT POLICLINICA SAN PEDRO
Entity Type:Organization
Organization Name:FARMACIA CDT POLICLINICA SAN PEDRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:SANDALIO
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-839-3980
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0818
Mailing Address - Country:US
Mailing Address - Phone:787-839-3980
Mailing Address - Fax:787-271-1016
Practice Address - Street 1:211 CALLE MORSE
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2350
Practice Address - Country:US
Practice Address - Phone:787-839-3980
Practice Address - Fax:787-271-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-21943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy