Basic Information
| Provider Information | |||||||||
| NPI: | 1548390511 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FARMACIA HOSPITAL MENONITA CAYEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 373130 | ||||||||
| Address2: | |||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
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| Practice Location | |||||||||
| Address1: | BO RINCON INTERIOR CARRETERA NUMERO 14 | ||||||||
| Address2: | |||||||||
| City: | CAYEY PR | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 12/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | MERCADO | ||||||||
| AuthorizedOfficialFirstName: | MARTA | ||||||||
| AuthorizedOfficialMiddleName: | ROSA | ||||||||
| AuthorizedOfficialTitleorPosition: | MANEGER | ||||||||
| AuthorizedOfficialTelephone: | 7875351001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOSPITAL MENONITA DE CAYEY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 07-F-1202 | PR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 11-F-2703 | 01 | PR | HEALTH DEPARTMENT | OTHER |