Provider Demographics
NPI:1740329903
Name:FARMACIA SAN RAFAEL,INC
Entity type:Organization
Organization Name:FARMACIA SAN RAFAEL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:PIQUET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-895-2121
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1546
Mailing Address - Country:US
Mailing Address - Phone:787-895-2121
Mailing Address - Fax:787-895-6944
Practice Address - Street 1:165 CALLE SAN JUSTO
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1739
Practice Address - Country:US
Practice Address - Phone:787-895-2121
Practice Address - Fax:787-895-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-23043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07-F-2304OtherPHARMACY LICENSE
PR4005167OtherNCPDP