Provider Demographics
NPI:1699763326
Name:FARMACIA SAN JOSE LLC
Entity type:Organization
Organization Name:FARMACIA SAN JOSE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:L
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-454-6473
Mailing Address - Street 1:3 CALLE SAN JOSE
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-2432
Mailing Address - Country:US
Mailing Address - Phone:787-897-1500
Mailing Address - Fax:787-897-2655
Practice Address - Street 1:3 CALLE SAN JOSE
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2432
Practice Address - Country:US
Practice Address - Phone:787-897-1500
Practice Address - Fax:787-897-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4004254OtherNABP
PR4004254OtherNABP