Provider Demographics
NPI:1831666437
Name:PUEBLO INC
Entity type:Organization
Organization Name:PUEBLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-757-3131
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1967
Mailing Address - Country:US
Mailing Address - Phone:787-757-3131
Mailing Address - Fax:787-793-8144
Practice Address - Street 1:ALTURAS DE TORRIMAR
Practice Address - Street 2:AVE SANTA ANA ESQ CALLE 2
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-790-1196
Practice Address - Fax:787-272-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy