Provider Demographics
NPI:1295936037
Name:JORGE L RIOS FLORAN
Entity type:Organization
Organization Name:JORGE L RIOS FLORAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS FLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-334-9338
Mailing Address - Street 1:AVENIDA DUERO BLOQUE 3 NUM 5 LOCAL 2
Mailing Address - Street 2:URBANIZACION MIRAFLORES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-797-2746
Mailing Address - Fax:787-797-2746
Practice Address - Street 1:AVENIDA DUERO BLOQUE 3 NUM 5 LOCAL 2
Practice Address - Street 2:URBANIZACION MIRAFLORES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-797-2746
Practice Address - Fax:787-797-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
PR2552-113336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4014596OtherNCPDP PROVIDER IDENTIFICATION NUMBER