Provider Demographics
NPI:1750414470
Name:CANOPHARM INC.
Entity type:Organization
Organization Name:CANOPHARM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORRERO
Authorized Official - Suffix:
Authorized Official - Credentials:BD
Authorized Official - Phone:787-876-3400
Mailing Address - Street 1:AA-12 CALLE BAUHINIA STE 1
Mailing Address - Street 2:URB. LOIZA VALLEY
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3440
Mailing Address - Country:US
Mailing Address - Phone:787-876-3400
Mailing Address - Fax:787-876-7631
Practice Address - Street 1:AA-12 CALLE BAUHINIA STE1
Practice Address - Street 2:URB. LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3440
Practice Address - Country:US
Practice Address - Phone:787-876-3400
Practice Address - Fax:787-876-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1762333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4022315OtherNABP