Provider Demographics
NPI:1730629601
Name:AITANA PONCE LLC
Entity type:Organization
Organization Name:AITANA PONCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MERCADO GALARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-254-9401
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-0535
Mailing Address - Country:US
Mailing Address - Phone:787-254-9401
Mailing Address - Fax:787-804-0801
Practice Address - Street 1:CARRETERA 121 KM 4.8
Practice Address - Street 2:BO MAGINAS
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-254-9401
Practice Address - Fax:787-804-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19-F-34683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy