Provider Demographics
NPI:1003162967
Name:CADIZ, CARLO (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARLO
Middle Name:
Last Name:CADIZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-1405
Mailing Address - Country:US
Mailing Address - Phone:732-322-2931
Mailing Address - Fax:
Practice Address - Street 1:2411 N PROCTOR ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5335
Practice Address - Country:US
Practice Address - Phone:253-752-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60256880183500000X
FLPS40945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist