Provider Demographics
NPI:1447344742
Name:FARMACIA FELICIANO, INC
Entity type:Organization
Organization Name:FARMACIA FELICIANO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:787-893-2280
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0490
Mailing Address - Country:US
Mailing Address - Phone:787-893-2280
Mailing Address - Fax:787-893-5819
Practice Address - Street 1:#5 CRISTOBAL COLON STREET
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0490
Practice Address - Country:US
Practice Address - Phone:787-893-2280
Practice Address - Fax:787-893-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-1116332B00000X
PR40148373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4014837OtherNBPA
PR1177930001Medicare NSC