Provider Demographics
NPI:1932367299
Name:DARITZABEL MONROIG MARTIR
Entity Type:Organization
Organization Name:DARITZABEL MONROIG MARTIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARITZABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-546-0659
Mailing Address - Street 1:PO BOX 4993
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4993
Mailing Address - Country:US
Mailing Address - Phone:787-546-0659
Mailing Address - Fax:787-830-8585
Practice Address - Street 1:CARR 472 KM 2.3 AVE ESTACION
Practice Address - Street 2:357
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-8585
Practice Address - Fax:787-609-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR20-F-26103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087881OtherPK