Provider Demographics
NPI:1386975423
Name:SAMS CLUB #6690
Entity type:Organization
Organization Name:SAMS CLUB #6690
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RETAIL STRATEGIC BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-8094
Mailing Address - Street 1:2180 AVE. EDUARDO RUBERTE
Mailing Address - Street 2:BO. PAMPANOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-844-7524
Mailing Address - Fax:787-812-1825
Practice Address - Street 1:2180 AVE. EDUARDO RUBERTE
Practice Address - Street 2:BO. PAMPANOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-844-7524
Practice Address - Fax:787-812-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier