Provider Demographics
NPI:1194895896
Name:KO'E PYAHU GROUP, INC.
Entity type:Organization
Organization Name:KO'E PYAHU GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZORAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-6835
Mailing Address - Street 1:148 AVE PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5726
Mailing Address - Country:US
Mailing Address - Phone:787-891-6835
Mailing Address - Fax:787-891-6835
Practice Address - Street 1:148 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5726
Practice Address - Country:US
Practice Address - Phone:787-891-6835
Practice Address - Fax:787-891-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08F23613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR08F2361OtherLICENCIA SALUD