Healthcare Provider Details

I. General information

NPI: 1124637079
Provider Name (Legal Business Name): CAROLINA LIRIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

15475 SW 114TH ST
MIAMI FL
33196-4386
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0600
  • Fax:
Mailing address:
  • Phone: 786-302-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61119
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS61119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: