Provider Demographics
NPI:1902623523
Name:FARMACIA SAN JOSE LOS CAOBOS LLC
Entity type:Organization
Organization Name:FARMACIA SAN JOSE LOS CAOBOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:AMALIA
Authorized Official - Last Name:LEON-YORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-237-6970
Mailing Address - Street 1:URB CAMINO DEL SUR
Mailing Address - Street 2:464 CALLE GAVIOTA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-237-6970
Mailing Address - Fax:
Practice Address - Street 1:URB LOS CAOBOS
Practice Address - Street 2:CALLE CAOBA SUITE #5
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-237-6970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy