Basic Information
| Provider Information | |||||||||
| NPI: | 1114082724 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | FARMACIA CARIDAD #2 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4218 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009581218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877877733 | ||||||||
| FaxNumber: | 7877473463 | ||||||||
| Practice Location | |||||||||
| Address1: | URB LOS ANGELES | ||||||||
| Address2: | AVE. LAS FLORES WD 22 | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872537195 | ||||||||
| FaxNumber: | 7872533892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 11/02/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YASSIN | ||||||||
| AuthorizedOfficialFirstName: | MANNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CIO/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7875471991 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 07-F-2012 | PR | N | Suppliers | Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.