Provider Demographics
NPI:1104268143
Name:FARMACIA BUENA VIDA
Entity type:Organization
Organization Name:FARMACIA BUENA VIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LILLIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-559-2390
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00707
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-2148
Practice Address - Country:US
Practice Address - Phone:787-559-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy