Provider Demographics
NPI:1780791400
Name:FARMACIA GRUPO MARIO CANALES TORRESOLA
Entity type:Organization
Organization Name:FARMACIA GRUPO MARIO CANALES TORRESOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-282-0259
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0488
Mailing Address - Country:US
Mailing Address - Phone:787-282-0282
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE CEMENTERIO
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1452
Practice Address - Country:US
Practice Address - Phone:787-282-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-2223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty