Provider Demographics
NPI:1063555357
Name:FARMACIA LA FE REFORMADA INC
Entity type:Organization
Organization Name:FARMACIA LA FE REFORMADA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-844-3155
Mailing Address - Street 1:CALLE VICTORIA
Mailing Address - Street 2:STE 108
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3767
Mailing Address - Country:US
Mailing Address - Phone:787-842-3201
Mailing Address - Fax:787-848-0858
Practice Address - Street 1:CALLE VICTORIA
Practice Address - Street 2:STE 108
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3767
Practice Address - Country:US
Practice Address - Phone:787-844-3155
Practice Address - Fax:787-848-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17F03633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130998OtherPK