Provider Demographics
NPI:1699947614
Name:FARMACIA SAGRADO CORAZON EXPRESS
Entity type:Organization
Organization Name:FARMACIA SAGRADO CORAZON EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ILIANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-873-7676
Mailing Address - Street 1:URB SANTA MARIA 139
Mailing Address - Street 2:CALLE PEDRO DE ACOSTA
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-873-1182
Mailing Address - Fax:787-873-1182
Practice Address - Street 1:ED DORA PAGANELLI LOCAL 2
Practice Address - Street 2:AVE VICENTE QUILINCHINI
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-7676
Practice Address - Fax:787-873-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR20F33483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087603OtherPK