Healthcare Provider Details

I. General information

NPI: 1831914985
Provider Name (Legal Business Name): CARL KYLLE PITRE ROSA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARR 140
BARCELONETA PR
00617-2261
US

IV. Provider business mailing address

5 CALLE ESPERANZA
CAMUY PR
00627-2640
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-6829
  • Fax:
Mailing address:
  • Phone: 787-439-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8306
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: