Provider Demographics
NPI:1902164387
Name:FARMACIA SAN MIGUEL SL INC
Entity Type:Organization
Organization Name:FARMACIA SAN MIGUEL SL INC
Other - Org Name:FARMACIA SAN MIGUEL SL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-218-1073
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0593
Mailing Address - Country:US
Mailing Address - Phone:939-218-1073
Mailing Address - Fax:
Practice Address - Street 1:CARRT. 181 KM 0.6 INT. CARRT. 183
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-2900
Practice Address - Fax:787-736-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
PR14F30203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4028115OtherNCPDP PROVIDER IDENTIFICATION NUMBER