Provider Demographics
NPI:1396036380
Name:PHARMACY COSSMA YABUCOA
Entity type:Organization
Organization Name:PHARMACY COSSMA YABUCOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISOLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-739-8182
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1330
Mailing Address - Country:US
Mailing Address - Phone:787-739-8182
Mailing Address - Fax:787-893-3055
Practice Address - Street 1:BARRIO JUAN MARTIN CARR 901 KM. 1.6
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0067
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:787-893-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13F29373336C0002X, 3336C0003X
13F29373336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy