Provider Demographics
NPI:1801337605
Name:RM SUPERMARKET SAN PATRICIO INC
Entity type:Organization
Organization Name:RM SUPERMARKET SAN PATRICIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-640-7362
Mailing Address - Street 1:CENTRAL PLAZA SHOPPING CENTER SUITE #1
Mailing Address - Street 2:1645 JESUS T.PINERO AVE.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-705-0938
Mailing Address - Fax:787-705-8675
Practice Address - Street 1:CENTRAL PLAZA SHOPPING CENTER SUITE #1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-705-0938
Practice Address - Fax:787-705-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19-F-34733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175387OtherPK