Provider Demographics
NPI:1932629466
Name:FARMACIA EXPRESS
Entity Type:Organization
Organization Name:FARMACIA EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-866-2222
Mailing Address - Street 1:CARR. 3 KM 134.8 PLAZA GUAYAMA MALL
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-866-2222
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 KM 134.8
Practice Address - Street 2:PLAZA GUAYAMA MALL
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19-F3428333600000X
3336C0003X
PR3336C0003X
19FF-34283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy