{"npi":"1396810156","type":"NPI-2","status":"active","name":{"display":"Super Farmacia San Jose De Aibonito INC","other":[],"organization_name":"SUPER FARMACIA SAN JOSE DE AIBONITO INC","authorised_official":"Rafael Rivera Olivencia"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"333600000X","description":"Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":false,"state":"PR","license":"19-F-3483"},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"300 CALLE SAN JOSE ESQ MERCEDITA SERRALLES","city":"AIBONITO","state":"PR","postal_code":"00705","country_code":"US","phone":"7877353025","fax":"7877352725"},{"purpose":"MAILING","street_1":"PO BOX 2021","city":"AIBONITO","state":"PR","postal_code":"007052021","country_code":"US","phone":"7877353025","fax":"7877352725"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"037722100","state":"PR","issuer":null},{"type_code":"01","label":"Other","value":"2085519","state":null,"issuer":"PK"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20190510000128","type_code":"12-A5","type_desc":"PART B SUPPLIER - PHARMACY","state":"PR","pac_id":"4587907712"}]},"enumeration_date":"2006-11-21","last_updated":"2025-07-21","_meta":{"source":"NPPES","snapshot_date":"2025-07-21","doc_url":"https://findmynpi.com/api"}}