Provider Demographics
NPI:1992109839
Name:DAMAR OF PUERTO RICO SERVICES INC
Entity type:Organization
Organization Name:DAMAR OF PUERTO RICO SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-547-3240
Mailing Address - Street 1:PO BOX 25130
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-5130
Mailing Address - Country:US
Mailing Address - Phone:787-296-1225
Mailing Address - Fax:787-296-1225
Practice Address - Street 1:CALLE 8 ESQ. CALLE 45
Practice Address - Street 2:PARCELAS FALU, SABANA LLANA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-296-1225
Practice Address - Fax:787-296-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-31973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149771OtherPK