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NPI Code Detail

MEDICARE: JANUARY CARRILLO

MEDICARE: JANUARY CARRILLO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist56376TX

General Provider Information

NPI Number : 1366043283
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANUARY CARRILLO
Provider Business Mailing Address
First Line : 2300 LAFAYETTE DR
Second Line :
City : HEATH
State : TX
Zip : 75032-7642
Country : US
Telephone Number : 915-256-2436
Fax Number :
Provider Business Practice Location Address
First Line : 12300 LAKE JUNE RD
Second Line :
City : BALCH SPRINGS
State : TX
Zip : 75180-1636
Country : US
Telephone Number : 972-286-0180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2020
Last Update Date : 11/06/2020

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Directions to “ JANUARY CARRILLO ” Practice Location

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