Provider Demographics
NPI:1386787364
Name:PORTAL INC. FARMACIA LUCIANO
Entity type:Organization
Organization Name:PORTAL INC. FARMACIA LUCIANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PORTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-5200
Mailing Address - Street 1:MENDEZ VIGO 67 ESTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-5200
Mailing Address - Fax:787-805-4030
Practice Address - Street 1:MENDEZ VIGO 67 ESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-5200
Practice Address - Fax:787-805-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4335183500000X
PR07-F-0899333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered333600000XSuppliersPharmacy