Provider Demographics
NPI:1982791042
Name:FARMACIA GLAMAR
Entity Type:Organization
Organization Name:FARMACIA GLAMAR
Other - Org Name:ANGEL R. BURGOS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-858-0052
Mailing Address - Street 1:457 AVE FELISA RINCON DE GAUTIER
Mailing Address - Street 2:URB. SAN DEMETRIO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3375
Mailing Address - Country:US
Mailing Address - Phone:787-858-0058
Mailing Address - Fax:787-858-5547
Practice Address - Street 1:457 AVE FELISA RINCON DE GAUTIER
Practice Address - Street 2:URB. SAN DEMETRIO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3375
Practice Address - Country:US
Practice Address - Phone:787-858-0058
Practice Address - Fax:787-858-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07F1597OtherHEALTH DEPARTMENT
PR4021250OtherNABP
PR07F1597OtherHEALTH DEPARTMENT