Provider Demographics
NPI:1063430429
Name:SUPER FARMACIA NELIA
Entity type:Organization
Organization Name:SUPER FARMACIA NELIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-804-0131
Mailing Address - Street 1:16 CALLE FRANCISCO M QUINONEZ
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1945
Mailing Address - Country:US
Mailing Address - Phone:787-873-0198
Mailing Address - Fax:787-873-3166
Practice Address - Street 1:16 CALLE FRANCISCO M QUINONEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1945
Practice Address - Country:US
Practice Address - Phone:787-873-0198
Practice Address - Fax:787-873-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4015675OtherNABP
PR4015675OtherNABP