Provider Demographics
NPI:1932185824
Name:FARMACIA EL TUQUE
Entity Type:Organization
Organization Name:FARMACIA EL TUQUE
Other - Org Name:FARMACIA EL TUQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-844-2805
Mailing Address - Street 1:553 CALLE RAMOS ANTONINI
Mailing Address - Street 2:PARC EL TUQUE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-4806
Mailing Address - Country:US
Mailing Address - Phone:787-844-2805
Mailing Address - Fax:787-841-5551
Practice Address - Street 1:553 CALLE RAMOS ANTONINI
Practice Address - Street 2:EL TUQUE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4806
Practice Address - Country:US
Practice Address - Phone:787-844-2805
Practice Address - Fax:787-841-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06-F-2252333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4016906OtherNCPDP
PR038397600Medicaid