Provider Demographics
NPI:1861682973
Name:FARMACIA DIVINA PRESENCIA, INC.
Entity type:Organization
Organization Name:FARMACIA DIVINA PRESENCIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.R
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-782-0489
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:PMB # 94
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-782-0489
Mailing Address - Fax:787-781-8273
Practice Address - Street 1:CALLE 7 NE, #322
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-782-0489
Practice Address - Fax:787-781-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-2525333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4020311OtherNCPDP