Provider Demographics
NPI:1588600407
Name:SOCIEDAD HNOS MAHIQUES
Entity type:Organization
Organization Name:SOCIEDAD HNOS MAHIQUES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHIQUES NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-898-3975
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0067
Mailing Address - Country:US
Mailing Address - Phone:787-898-3975
Mailing Address - Fax:787-820-9048
Practice Address - Street 1:121 CALLE VIDAL FELIX
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1818
Practice Address - Country:US
Practice Address - Phone:787-898-3975
Practice Address - Fax:787-820-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
PR13F02183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4000903OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3923910001Medicare NSC