Provider Demographics
NPI:1023364528
Name:PRESCRIPTION HEALTH RESOURCES OF PUERTO RICO LLC
Entity type:Organization
Organization Name:PRESCRIPTION HEALTH RESOURCES OF PUERTO RICO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-545-2073
Mailing Address - Street 1:A1 CALLE ARPEGIO # 2
Mailing Address - Street 2:HIGHLAND GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3519
Mailing Address - Country:US
Mailing Address - Phone:787-545-2073
Mailing Address - Fax:787-545-4702
Practice Address - Street 1:A1 CALLE ARPEGIO # 2
Practice Address - Street 2:HIGHLAND GARDENS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3519
Practice Address - Country:US
Practice Address - Phone:787-545-2073
Practice Address - Fax:787-545-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336C0003X
PR17F33003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137829OtherPK