Healthcare Provider Details

I. General information

NPI: 1437983830
Provider Name (Legal Business Name): CHRISTINA MARIA CARRILLO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E GRANT RD
TUCSON AZ
85705-5770
US

IV. Provider business mailing address

555 E GRANT RD
TUCSON AZ
85705-5770
US

V. Phone/Fax

Practice location:
  • Phone: 520-628-9428
  • Fax: 520-624-2309
Mailing address:
  • Phone: 520-628-9428
  • Fax: 520-624-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS027109
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: