Provider Demographics
NPI:1104133990
Name:ONE STOP PRESCRIPTION EL MONTE INC
Entity type:Organization
Organization Name:ONE STOP PRESCRIPTION EL MONTE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-751-9606
Mailing Address - Street 1:10 AVE SIMON MADERA
Mailing Address - Street 2:PARCELAS FALU
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2231
Mailing Address - Country:US
Mailing Address - Phone:787-751-9606
Mailing Address - Fax:787-751-0286
Practice Address - Street 1:CENTRO COMERCIAL DORADO DEL MAR
Practice Address - Street 2:CARR 693 KM 8
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-278-6010
Practice Address - Fax:787-796-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR18-F-28833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126420OtherPK