Basic Information
| Provider Information | |||||||||
| NPI: | 1316230519 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | FARMACIA CARIDAD #6 | ||||||||
| 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: | 7872690022 | ||||||||
| Practice Location | |||||||||
| Address1: | VICTORY SHOPP | ||||||||
| Address2: | PR-167 KM 2.6 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009572307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877404000 | ||||||||
| FaxNumber: | 7877400800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| 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: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 17F2950 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2130469 | 01 | PK | OTHER |