Provider Demographics
NPI:1356560973
Name:SUPERMERCADO Y FARMACIA CAGUANA
Entity type:Organization
Organization Name:SUPERMERCADO Y FARMACIA CAGUANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-894-8283
Mailing Address - Street 1:P.O. BOX 471
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-894-8283
Mailing Address - Fax:787-894-8283
Practice Address - Street 1:ROAD 111 KM 8.2
Practice Address - Street 2:BO. CAGUANA
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-894-7281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy