Basic Information
| Provider Information | |||||||||
| NPI: | 1518323039 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
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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: | CARR 2 KM 54.6 INTERIOR PRIME OUTLETS BOULEVARD LOCAL 2 | ||||||||
| Address2: | |||||||||
| City: | BARCELONETA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877866385 | ||||||||
| FaxNumber: | 7879667299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | YASSIN | ||||||||
| AuthorizedOfficialFirstName: | MANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 7875471991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | 19-F-3532 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2157454 | 01 | PK | OTHER |