Healthcare Provider Details

I. General information

NPI: 1871632679
Provider Name (Legal Business Name): CARLOS E FERNANDEZ PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALLE BARCOLO TU FARMACIA FAMILIAR
MAUNABO PR
00707
US

IV. Provider business mailing address

HC 1 BOX 4498
YABUCOA PR
00767-9604
US

V. Phone/Fax

Practice location:
  • Phone: 787-861-4855
  • Fax: 787-861-1056
Mailing address:
  • Phone: 787-266-5142
  • Fax: 787-861-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4458
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: