Provider Demographics
NPI:1982734620
Name:FARMACIA SAGRADO CORAZON
Entity Type:Organization
Organization Name:FARMACIA SAGRADO CORAZON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-882-0135
Mailing Address - Street 1:PO BOX 3088
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3088
Mailing Address - Country:US
Mailing Address - Phone:787-882-0135
Mailing Address - Fax:787-882-0185
Practice Address - Street 1:CARR. #2 KM.122.0 BO. CORRALES
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-0135
Practice Address - Fax:787-882-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-20403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy