Basic Information
| Provider Information | |||||||||
| NPI: | 1376758482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FARMACIA METRO PAVIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190828 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009190828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876412323 | ||||||||
| FaxNumber: | 7877714546 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 AVE PONCE DE LEON | ||||||||
| Address2: | |||||||||
| City: | HATO REY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009173428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876412323 | ||||||||
| FaxNumber: | 7877714546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MUNOZ | ||||||||
| AuthorizedOfficialFirstName: | ASTRO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7876412323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MHSA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 09-F-2480 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.