Basic Information
| Provider Information | |||||||||
| NPI: | 1518011758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUPER FARMACIA ARZUAGA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | CAROLINA SHOPPING COURT | ||||||||
| Address2: | LOCAL 103-B CARR#3 ESQ ROBERTO CLEMENTE | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877672626 | ||||||||
| FaxNumber: | 7877672626 | ||||||||
| Practice Location | |||||||||
| Address1: | CAROLINA SHOPPING COURT 1 | ||||||||
| Address2: | LOCAL 103-B CARR#3 ESQ ROBERTO CLEMENTE | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877672626 | ||||||||
| FaxNumber: | 7877672626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | EDGARDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877672626 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CEO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 09-F-0307 | PR | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | 20F3554 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4016641 | 01 | PR | NCPDP | OTHER |