Provider Demographics
NPI:1215064845
Name:FARMACIA DON BOSCO
Entity type:Organization
Organization Name:FARMACIA DON BOSCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-782-8017
Mailing Address - Street 1:PO BOX 5012
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-5012
Mailing Address - Country:US
Mailing Address - Phone:787-782-8017
Mailing Address - Fax:787-783-5689
Practice Address - Street 1:CALLE 12 SE 1114 CAPARRA TERRACE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-782-8017
Practice Address - Fax:787-783-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F21803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4005939Medicare UPIN
PR5257240001Medicare NSC