Provider Demographics
NPI:1366827040
Name:COSSMA
Entity type:Organization
Organization Name:COSSMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECNICA DE FARMACIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEDIS
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-436-7470
Mailing Address - Street 1:HC #4 BOX 6737
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00767
Mailing Address - Country:UM
Mailing Address - Phone:787-436-7470
Mailing Address - Fax:
Practice Address - Street 1:CALLE ULISES MARTINEZ NORTE 50
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00791
Practice Address - Country:UM
Practice Address - Phone:787-739-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9458333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy