Provider Demographics
NPI:1902951692
Name:INTRACARE INFUSION AND COMPOUNDING PHCY
Entity Type:Organization
Organization Name:INTRACARE INFUSION AND COMPOUNDING PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-250-1515
Mailing Address - Street 1:690 CALLE CESAR GONZALEZ # 479
Mailing Address - Street 2:URB ROOSEVELT
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 CALLE CESAR GONZALEZ # 479
Practice Address - Street 2:URB ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3901
Practice Address - Country:US
Practice Address - Phone:787-250-1515
Practice Address - Fax:787-753-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336S0011X
PR08F24563336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4025563OtherOTHER ID NUMBER
4025563OtherOTHER ID NUMBER-COMMERCIAL NUMBER