Provider Demographics
NPI:1528050192
Name:FARMACIA DEL CONDADO, INC CSP
Entity type:Organization
Organization Name:FARMACIA DEL CONDADO, INC CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SENERIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-0001
Mailing Address - Street 1:H18 CALLE JOSE VILLARES
Mailing Address - Street 2:CONDADO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2463
Mailing Address - Country:US
Mailing Address - Phone:787-743-0001
Mailing Address - Fax:787-743-0001
Practice Address - Street 1:H18 CALLE JOSE VILLARES
Practice Address - Street 2:CONDADO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2463
Practice Address - Country:US
Practice Address - Phone:787-743-0001
Practice Address - Fax:787-743-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1184760001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1184760001Medicare ID - Type UnspecifiedPHARMACY