Provider Demographics
NPI:1740321959
Name:SUPER FARMACIA MI BTOTICA
Entity type:Organization
Organization Name:SUPER FARMACIA MI BTOTICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FARMACEUTICA
Authorized Official - Prefix:
Authorized Official - First Name:MAYTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIZCARRONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-630-7989
Mailing Address - Street 1:IGNACIO ARZUAGA STREET #5-E
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-769-0058
Mailing Address - Fax:787-768-0855
Practice Address - Street 1:IGNACIO ARZUAGA STREET #5-E
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-0058
Practice Address - Fax:787-768-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-17403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4021301OtherNABP
PRDF-02403-4OtherASSMCA NUMBER
PRDF-02403-4OtherASSMCA NUMBER
PRDF-02403-4OtherASSMCA NUMBER