Provider Demographics
NPI:1841344942
Name:FARMACIA SAN ANTONIO
Entity type:Organization
Organization Name:FARMACIA SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-2190
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0449
Mailing Address - Country:US
Mailing Address - Phone:787-869-2190
Mailing Address - Fax:787-869-6026
Practice Address - Street 1:108 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3011
Practice Address - Country:US
Practice Address - Phone:787-869-2190
Practice Address - Fax:787-869-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-01413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy