Provider Demographics
NPI:1982755872
Name:FARMACIA LASALLE NIEVES INC
Entity Type:Organization
Organization Name:FARMACIA LASALLE NIEVES INC
Other - Org Name:FARMACIA LASALLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES-CURBELO
Authorized Official - Suffix:
Authorized Official - Credentials:PH
Authorized Official - Phone:787-895-1001
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0976
Mailing Address - Country:US
Mailing Address - Phone:787-895-1001
Mailing Address - Fax:787-895-1882
Practice Address - Street 1:CARR 113 KM 11.6
Practice Address - Street 2:CACAO WARD
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-2621
Practice Address - Country:US
Practice Address - Phone:787-895-1001
Practice Address - Fax:787-895-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-12073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07-F-1207OtherSTATE LISCENCE
PRDF-01770-7OtherSTATE CONTROLLED SUBSTANC
PRDF-01770-7OtherSTATE CONTROLLED SUBSTANC