Provider Demographics
NPI:1952434912
Name:FARMACIA SAN JORGE CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:FARMACIA SAN JORGE CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP SENIORS OPERATION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-727-1000
Mailing Address - Street 1:PO BOX 6308
Mailing Address - Street 2:LOIZA STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-6308
Mailing Address - Country:US
Mailing Address - Phone:787-727-1000
Mailing Address - Fax:787-727-0550
Practice Address - Street 1:260 CALLE CONVENTO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3207
Practice Address - Country:US
Practice Address - Phone:787-727-1000
Practice Address - Fax:787-727-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08F24643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4021313OtherNABP