Provider Demographics
NPI:1992887772
Name:JESSICA I RAMIREZ RAMOS
Entity type:Organization
Organization Name:JESSICA I RAMIREZ RAMOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-899-1476
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1690
Mailing Address - Country:US
Mailing Address - Phone:787-899-4356
Mailing Address - Fax:787-899-6058
Practice Address - Street 1:CALLE 116 KM 1.3
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-4356
Practice Address - Fax:787-899-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR11F25483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4010738OtherNCPDP PROVIDER IDENTIFICATION NUMBER