Provider Demographics
NPI:1497015481
Name:INTERAMERICAN UNLIMITED DRUG INC
Entity type:Organization
Organization Name:INTERAMERICAN UNLIMITED DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULLAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:YASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-929-7505
Mailing Address - Street 1:PO BOX 51028
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1028
Mailing Address - Country:US
Mailing Address - Phone:787-857-8800
Mailing Address - Fax:787-857-8800
Practice Address - Street 1:CARRETERA 152 KM 8.0
Practice Address - Street 2:BARRIO QUEBRADILLAS
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-8800
Practice Address - Fax:787-857-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR20-F-30343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135297OtherPK