Provider Demographics
NPI:1487129672
Name:SHADDAI PHARMACY #2 INC
Entity type:Organization
Organization Name:SHADDAI PHARMACY #2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-691-2518
Mailing Address - Street 1:14 CALLE OPALO
Mailing Address - Street 2:MANSIONES DEL CARIBE
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-691-2518
Mailing Address - Fax:787-991-7695
Practice Address - Street 1:CARR PR 924 KM 2.8 SECTOR PITAHAYA BO COLLORES
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-991-7696
Practice Address - Fax:787-991-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy