Basic Information
| Provider Information | |||||||||
| NPI: | 1952454423 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUPER FARMAACIA IDEAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29003 | ||||||||
| Address2: | 65 INFANTERIA STATION | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877529120 | ||||||||
| FaxNumber: | 7877761148 | ||||||||
| Practice Location | |||||||||
| Address1: | CENTRO COMERCIAL EL COMANDANTE | ||||||||
| Address2: | AVE. 65 INF. ESQ. SAN MARCOS | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877529120 | ||||||||
| FaxNumber: | 7877761148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUERRERO | ||||||||
| AuthorizedOfficialFirstName: | YARIMAR | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7877529120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 07-F-2123 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.