Provider Demographics
NPI:1306304837
Name:SUPERDRUG-YIGO
Entity type:Organization
Organization Name:SUPERDRUG-YIGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALMACIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:671-633-3684
Mailing Address - Street 1:655 HARMON LOOP RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6544
Mailing Address - Country:US
Mailing Address - Phone:671-633-3684
Mailing Address - Fax:671-633-3680
Practice Address - Street 1:525 CHALAN RAMON HAYA
Practice Address - Street 2:
Practice Address - City:YIGO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-633-3684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy