Provider Demographics
NPI:1881821874
Name:HPM FOUNDATION INC FARMACIA CCB
Entity type:Organization
Organization Name:HPM FOUNDATION INC FARMACIA CCB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-268-4171
Mailing Address - Street 1:2016 AVENIDA BORINQUEN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3823
Mailing Address - Country:US
Mailing Address - Phone:787-268-4171
Mailing Address - Fax:787-919-3956
Practice Address - Street 1:2016 AVENIDA BORINQUEN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3823
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:787-919-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037521100Medicaid