Basic Information
Provider Information | |||||||||
NPI: | 1023249208 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FARMACIA CARIDAD | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 4218 | ||||||||
Address2: |   | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 009581218 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877529644 | ||||||||
FaxNumber: | 7872690022 | ||||||||
Practice Location | |||||||||
Address1: | CALLE 615 BLOQUE 297 URB VILLA CAROLINA | ||||||||
Address2: |   | ||||||||
City: | CAROLIN | ||||||||
State: | PR | ||||||||
PostalCode: | 00985 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877529644 | ||||||||
FaxNumber: | 7872570770 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2009 | ||||||||
LastUpdateDate: | 11/02/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | YASSIN | ||||||||
AuthorizedOfficialFirstName: | MANNA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CIO/CFO | ||||||||
AuthorizedOfficialTelephone: | 7875471991 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 11-F-2749 | PR | Y |   | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
ID | Type | State | Issuer | Description | 11-F-2749 | 01 | PR | STATE LICENSE | OTHER |