Provider Demographics
NPI:1447493648
Name:FARMACIA FENIX INC
Entity type:Organization
Organization Name:FARMACIA FENIX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-890-7115
Mailing Address - Street 1:PO BOX 3758
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3758
Mailing Address - Country:US
Mailing Address - Phone:787-890-7115
Mailing Address - Fax:787-890-4366
Practice Address - Street 1:CARR 110 KM 9.8 GATE 5
Practice Address - Street 2:BO MALEZA ALTA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-890-7115
Practice Address - Fax:787-890-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11F27053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4026743OtherNCPDP PROVIDER IDENTIFICATION NUMBER