Provider Demographics
NPI:1841339538
Name:ERICK J QUINONES PABON
Entity type:Organization
Organization Name:ERICK J QUINONES PABON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-726-0295
Mailing Address - Street 1:PO BOX 19723
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1723
Mailing Address - Country:US
Mailing Address - Phone:787-726-0295
Mailing Address - Fax:787-726-8768
Practice Address - Street 1:2428 CALLE LOIZA
Practice Address - Street 2:PUNTA LAS MARIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913-4731
Practice Address - Country:US
Practice Address - Phone:787-726-0295
Practice Address - Fax:787-726-8768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMACIA LAUREL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PR07F12003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1129080001Medicare NSC