Provider Demographics
NPI:1861521569
Name:FARMACIA SAN MIGUEL
Entity type:Organization
Organization Name:FARMACIA SAN MIGUEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-863-1870
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0114
Mailing Address - Country:US
Mailing Address - Phone:787-863-1870
Mailing Address - Fax:787-863-1870
Practice Address - Street 1:54 CALLE DR LOPEZ W
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4635
Practice Address - Country:US
Practice Address - Phone:787-863-1870
Practice Address - Fax:787-863-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy