=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457246449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REYNALDO JOSE DE JESUS CARRASQUILLO PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2025
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CALLE MAGNOLIA STE 2
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784-6301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-864-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MIRADOR ECHEVARRIA CALLE FLAMBOYAN A3
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-738-7693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8368
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------