Provider Demographics
NPI:1740368513
Name:CAGUAS SUPERPHARMACY INC
Entity type:Organization
Organization Name:CAGUAS SUPERPHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-745-3210
Mailing Address - Street 1:PO BOX 7139
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7139
Mailing Address - Country:US
Mailing Address - Phone:787-745-3210
Mailing Address - Fax:787-744-2605
Practice Address - Street 1:AVE DEGETAU ESQ
Practice Address - Street 2:LAS PIEDRAS VV-1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-3210
Practice Address - Fax:787-744-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1053380001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT