Provider Demographics
NPI:1063691095
Name:FARMACIA JIREH INC
Entity type:Organization
Organization Name:FARMACIA JIREH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISONET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-882-7900
Mailing Address - Street 1:213 URB VALLES DE ANASCO
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9601
Mailing Address - Country:US
Mailing Address - Phone:787-882-7900
Mailing Address - Fax:787-882-4916
Practice Address - Street 1:CARR 2 KM 122 CAIMITAL ALTO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-7900
Practice Address - Fax:787-882-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR18F26803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087581OtherPK