Provider Demographics
NPI:1386269033
Name:SAN JUAN PHARMACY LLC
Entity type:Organization
Organization Name:SAN JUAN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAGNESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:904-673-0588
Mailing Address - Street 1:200 W BUTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-2603
Mailing Address - Country:US
Mailing Address - Phone:484-339-0911
Mailing Address - Fax:484-339-1911
Practice Address - Street 1:200 W BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-2603
Practice Address - Country:US
Practice Address - Phone:484-339-0911
Practice Address - Fax:484-339-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy