Provider Demographics
NPI:1871872671
Name:MI FARMACIA SAN ISIDRO
Entity type:Organization
Organization Name:MI FARMACIA SAN ISIDRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACEUTICAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-256-0069
Mailing Address - Street 1:2 CALLE GUAYACAN
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9815
Mailing Address - Country:US
Mailing Address - Phone:787-256-0069
Mailing Address - Fax:787-256-0069
Practice Address - Street 1:2 CALLE GUAYACAN
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9815
Practice Address - Country:US
Practice Address - Phone:787-256-0069
Practice Address - Fax:787-256-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5089333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy