Provider Demographics
NPI:1316686413
Name:OPTIMA HEALTH RX, LLC
Entity type:Organization
Organization Name:OPTIMA HEALTH RX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIELY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-883-5959
Mailing Address - Street 1:HC 3 BOX 7525
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9539
Mailing Address - Country:US
Mailing Address - Phone:787-883-5959
Mailing Address - Fax:787-883-6040
Practice Address - Street 1:CARR 696 INT AVE. EFRON
Practice Address - Street 2:BO HIGUILLAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-625-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMA INFUSION PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-27
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF-1128108OtherLICENSE