Provider Demographics
NPI:1902945843
Name:FARMACIA COOPERATIVA SAN MIGUEL
Entity Type:Organization
Organization Name:FARMACIA COOPERATIVA SAN MIGUEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUREA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-4710
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0459
Mailing Address - Country:US
Mailing Address - Phone:787-869-4710
Mailing Address - Fax:787-869-1845
Practice Address - Street 1:152 STREET, KM 17.8
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0459
Practice Address - Country:US
Practice Address - Phone:787-869-4710
Practice Address - Fax:787-869-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1886333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy