Provider Demographics
NPI:1366593329
Name:TOA ALTA PHARMACY, INC
Entity type:Organization
Organization Name:TOA ALTA PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-870-1434
Mailing Address - Street 1:253 CALLE MENDEZ VIGO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4905
Mailing Address - Country:US
Mailing Address - Phone:787-870-1434
Mailing Address - Fax:787-870-0169
Practice Address - Street 1:253 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4905
Practice Address - Country:US
Practice Address - Phone:787-870-1434
Practice Address - Fax:787-870-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09F01893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSOCIAL SECURITY