MEDICARE: CARMEN BONILLA-RAMOS C.PH TECH

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
1	183700000X	Pharmacy Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	121439	OTHER	PR	C.PH.TECH

General Provider Information

NPI Number	:	1740422450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN BONILLA-RAMOS C.PH TECH

Provider Business Mailing Address
First Line	:	CALLE 9 BLQ 5 #20
Second Line	:	SABANA GARDEN
City	:	CAROLINA
State	:	PR
Zip	:	00983
Country	:	US
Telephone Number	:	787-701-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	5-20 CALLE 9
Second Line	:	SABANA GARDEN
City	:	CAROLINA
State	:	PR
Zip	:	00983-2916
Country	:	US
Telephone Number	:	787-701-6021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	03/26/2009

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