Provider Demographics
NPI:1366600207
Name:FARMACIA CENTRO PREVENCION Y TRATMIENTO DE
Entity type:Organization
Organization Name:FARMACIA CENTRO PREVENCION Y TRATMIENTO DE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPRV
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-2115
Mailing Address - Street 1:410 AVE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1560
Mailing Address - Country:US
Mailing Address - Phone:787-834-2115
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 # KM1570
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-834-2115
Practice Address - Fax:787-832-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10F26063336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4026349OtherNCPDP PROVIDER IDENTIFICATION NUMBER