Provider Demographics
NPI:1063892032
Name:GOOD SHEPHERD PHARMACY DBA MEDS DIRECT RX INC
Entity type:Organization
Organization Name:GOOD SHEPHERD PHARMACY DBA MEDS DIRECT RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-335-5400
Mailing Address - Street 1:PO BOX 250423
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0423
Mailing Address - Country:US
Mailing Address - Phone:787-335-5400
Mailing Address - Fax:
Practice Address - Street 1:CARR 459 KM 0.5 LOTE 2 CALLE GREGORIO SANDERS
Practice Address - Street 2:LA MONTANA INDUSTRIAL PARK
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-335-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17-F-32993336C0004X, 3336M0002X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy