Provider Demographics
NPI:1538381090
Name:FARMACIA SAN JOSE
Entity type:Organization
Organization Name:FARMACIA SAN JOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-739-2641
Mailing Address - Street 1:FARMACIA SAN JOSE
Mailing Address - Street 2:APARTADO 957
Mailing Address - City:CIDRA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00739
Mailing Address - Country:UM
Mailing Address - Phone:787-739-2641
Mailing Address - Fax:787-739-2641
Practice Address - Street 1:39 CALLE MUNOZ BARRIOS
Practice Address - Street 2:APARTADO 957
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3206
Practice Address - Country:US
Practice Address - Phone:787-739-2641
Practice Address - Fax:787-739-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002796333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy