Provider Demographics
NPI:1144468091
Name:FARMACIA MEDINA 6 INC
Entity type:Organization
Organization Name:FARMACIA MEDINA 6 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-957-7577
Mailing Address - Street 1:PO BOX 30000
Mailing Address - Street 2:APTDO. 577
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0013
Mailing Address - Country:US
Mailing Address - Phone:787-957-7577
Mailing Address - Fax:
Practice Address - Street 1:188 CALLE 1
Practice Address - Street 2:BO. SAN ISIDRO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-2650
Practice Address - Country:US
Practice Address - Phone:787-957-7577
Practice Address - Fax:787-876-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19-F-2695333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118822OtherPK