Provider Demographics
NPI:1366792376
Name:JIREH DRUGS, INC.
Entity type:Organization
Organization Name:JIREH DRUGS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCDA REGENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLYEDMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-421-5157
Mailing Address - Street 1:188 HACIENDA PRIMAVERA
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00739
Mailing Address - Country:UM
Mailing Address - Phone:787-421-5157
Mailing Address - Fax:
Practice Address - Street 1:CARR 172 KM 5.6
Practice Address - Street 2:BARRIO CANABONCITO
Practice Address - City:CAGUAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00725
Practice Address - Country:UM
Practice Address - Phone:787-421-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14F30553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy