Provider Demographics
NPI:1548916851
Name:FARMACIA VILLAS DE CASTRO INC.
Entity type:Organization
Organization Name:FARMACIA VILLAS DE CASTRO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-744-5544
Mailing Address - Street 1:PO BOX 8158
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8158
Mailing Address - Country:US
Mailing Address - Phone:787-744-5544
Mailing Address - Fax:787-746-0962
Practice Address - Street 1:CARR. 183 CALLE 2 A-18
Practice Address - Street 2:URB. VILLAS DE CASTRO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-5544
Practice Address - Fax:787-746-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037720300Medicaid