Provider Demographics
NPI:1841361243
Name:PROFESSIONAL PHARMACY LA PAZ PHARMACY INC
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY LA PAZ PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONROUZEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MBA HCM
Authorized Official - Phone:787-878-1548
Mailing Address - Street 1:CALLE JOSE RODRIGUEZ IRIZARRY #152
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-881-2440
Mailing Address - Fax:787-880-3258
Practice Address - Street 1:CARR #2 KM 62.7 BO SABANA HOYOS SECTOR CANDELARIA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-881-2440
Practice Address - Fax:787-880-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F23023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4017061OtherNCPDP