Provider Demographics
NPI:1528459435
Name:MONSERRATE PHARMACY
Entity type:Organization
Organization Name:MONSERRATE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUSEF
Authorized Official - Middle Name:MUSA
Authorized Official - Last Name:YASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-993-4741
Mailing Address - Street 1:PO BOX 8121
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0121
Mailing Address - Country:US
Mailing Address - Phone:787-725-6625
Mailing Address - Fax:787-725-6624
Practice Address - Street 1:MONSERRATE AVE., ESQUINA 209 ST
Practice Address - Street 2:DB#1 VALLE ARRIBA HEIGHTS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-752-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-F-07533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150144OtherPK