Provider Demographics
NPI:1780724740
Name:FARMACIA JOBOS
Entity type:Organization
Organization Name:FARMACIA JOBOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-872-3660
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0795
Mailing Address - Country:US
Mailing Address - Phone:787-872-3660
Mailing Address - Fax:787-830-2297
Practice Address - Street 1:8395 AVE JOBOS
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2179
Practice Address - Country:US
Practice Address - Phone:787-872-3660
Practice Address - Fax:787-830-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
PR07-F-17663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4903910003Medicare NSC
PR4017946Medicare UPIN