Provider Demographics
NPI:1104079904
Name:FARMACIA PROFESIONAL
Entity type:Organization
Organization Name:FARMACIA PROFESIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MT
Authorized Official - Phone:787-677-9324
Mailing Address - Street 1:22 CALLE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2209
Mailing Address - Country:US
Mailing Address - Phone:787-677-9324
Mailing Address - Fax:
Practice Address - Street 1:22 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2209
Practice Address - Country:US
Practice Address - Phone:787-677-9324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR51953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy