NPIMap

Organization Active NPI

Premium Pharmacy

  • Pharmacy
  • Carolina, PR
National Provider Identifier
1851442859
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
PREMIUM PHARMACY
Practice address
10 Ave Laguna
Laguna Garden SHP Ctr. #115
Carolina, PR 00979-6400
Phone
(787) 791-2171
Fax
(787) 253-1002
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Luz M Villanueva
Title
Ceo
Phone
(787) 444-4908

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

10 Ave Laguna
Laguna Garden SHP Ctr. #115
Carolina, PR 00979-6400

Mailing address

10 Ave Laguna
Laguna Garden SHP Ctr. #115
Carolina, PR 00979-6400
Phone (787) 791-2065

Other identifiers 1

IdentifierTypeStateIssuer
2135139OtherPK

Other names 2

  • Farmacia Luis #3 Doing business as
  • Premium Pharmacy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL RX30 Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210122002676 PR Part B Supplier - Pharmacy 0143634618 Practice locations: Carolina, PR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1851442859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 AVE LAGUNA",
            "address_2": "LAGUNA GARDEN SHP CTR. #115",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009796400",
            "telephone_number": "787-791-2065",
            "fax_number": "787-253-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 AVE LAGUNA",
            "address_2": "LAGUNA GARDEN SHP CTR. #115",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009796400",
            "telephone_number": "787-791-2171",
            "fax_number": "787-253-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "LUZ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "787-444-4908"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135139",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "RX30",
            "affiliation": "N",
            "endpointDescription": "RX30 Pharmacy Software",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Electronic",
            "address_1": "10 Ave Laguna",
            "address_2": "Laguna Garden Shp Ctr. #115",
            "city": "Carolina",
            "state": "PR",
            "country_code": "US",
            "postal_code": "009796400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Farmacia Luis #3",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premium Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carolina, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.