Provider Demographics
NPI:1841355989
Name:FARMACIA MEDINA # 2 INC.
Entity type:Organization
Organization Name:FARMACIA MEDINA # 2 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-876-3500
Mailing Address - Street 1:VILLAS DE LOIZA
Mailing Address - Street 2:CALLE 1 BLOQUE 1
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0000
Mailing Address - Country:US
Mailing Address - Phone:787-876-3500
Mailing Address - Fax:787-876-7751
Practice Address - Street 1:VILLAS DE LOIZA
Practice Address - Street 2:CALLE 1 BLOQUE 1
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-3500
Practice Address - Fax:787-876-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDF-01415-93336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4161880001Medicare NSC