Provider Demographics
NPI:1386979672
Name:FARMACIA EL BUEN PASTOR 2 LLC
Entity type:Organization
Organization Name:FARMACIA EL BUEN PASTOR 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-299-6927
Mailing Address - Street 1:HC 4 BOX 13792
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9750
Mailing Address - Country:US
Mailing Address - Phone:787-877-9922
Mailing Address - Fax:787-877-7284
Practice Address - Street 1:CARR 420 KM 2.2
Practice Address - Street 2:BARRIO VOLADORAS
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-9922
Practice Address - Fax:787-877-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17-F-2725333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122119OtherPK