Healthcare Provider Details

I. General information

NPI: 1598853053
Provider Name (Legal Business Name): CARLOS M MALDONADO PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 5377
PENUELAS PR
00624-9606
US

IV. Provider business mailing address

BO.RIO CANA CARRETERA 132 KM 22.1
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-1953
  • Fax: 787-290-1953
Mailing address:
  • Phone: 787-290-1953
  • Fax: 787-290-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3248
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: