Provider Demographics
NPI:1730754979
Name:PHARMACY EXPRESS
Entity type:Organization
Organization Name:PHARMACY EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IZETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEL MORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-540-5303
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0162
Mailing Address - Country:US
Mailing Address - Phone:904-540-5303
Mailing Address - Fax:
Practice Address - Street 1:CALLE CORCHADO FINAL
Practice Address - Street 2:CDT CANOVANAS BO. PUEBLO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:904-540-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICA GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-20
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy