Provider Demographics
NPI:1548977069
Name:PHARMA ANA
Entity type:Organization
Organization Name:PHARMA ANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:RENTERIA
Authorized Official - Last Name:ZAZUETA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:888-449-7799
Mailing Address - Street 1:HIDALGO 148-A SAN ANTONIO TLAYACAPAN
Mailing Address - Street 2:
Mailing Address - City:CHAPALA
Mailing Address - State:JALISCO
Mailing Address - Zip Code:45922
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HIDALGO 148-A SAN ANTONIO TLAYACAPAN
Practice Address - Street 2:
Practice Address - City:CHAPALA
Practice Address - State:JALISCO
Practice Address - Zip Code:45922
Practice Address - Country:MX
Practice Address - Phone:888-449-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CHA0896OtherSTATE