Provider Demographics
NPI:1396886693
Name:FARMACIA SAN JOSE HUMACAO LLC
Entity type:Organization
Organization Name:FARMACIA SAN JOSE HUMACAO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:EFREN
Authorized Official - Last Name:PEREZ VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-298-9705
Mailing Address - Street 1:CENTRO COMERCIAL SAN JOSE
Mailing Address - Street 2:375 CALLE DR VIDAL ESTE LOCAL 11
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-9494
Mailing Address - Fax:787-850-7811
Practice Address - Street 1:CENTRO COMERCIAL SAN JOSE 11
Practice Address - Street 2:375 CALLE DR VIDAL ESTE
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-9494
Practice Address - Fax:787-850-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17F10293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084712OtherPK