Provider Demographics
NPI:1639060312
Name:FARMACIA AMIGA EN PUERTO REAL LLC
Entity type:Organization
Organization Name:FARMACIA AMIGA EN PUERTO REAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-400-1588
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0506
Mailing Address - Country:US
Mailing Address - Phone:787-719-7828
Mailing Address - Fax:787-709-4786
Practice Address - Street 1:CARRETERA 308, KM. 5.1 BARRIO MIRADERO
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-719-7828
Practice Address - Fax:787-709-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy