Provider Demographics
NPI:1720280423
Name:SANTIAGO R. VARELA
Entity Type:Organization
Organization Name:SANTIAGO R. VARELA
Other - Org Name:FARMACIA HEIDI & BRAU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-868-3710
Mailing Address - Street 1:260 CALLE COLON
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2925
Mailing Address - Country:US
Mailing Address - Phone:787-868-3710
Mailing Address - Fax:787-868-2940
Practice Address - Street 1:260 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2925
Practice Address - Country:US
Practice Address - Phone:787-868-3710
Practice Address - Fax:787-868-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1314290001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1314290001Medicare NSC