Provider Demographics
NPI:1013038124
Name:MARQUEZ CARRILLO, ALICIA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MARQUEZ CARRILLO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 5-19 MONTE BRISAS V
Mailing Address - Street 2:BLOQ. 5 Q 12
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-435-1489
Mailing Address - Fax:
Practice Address - Street 1:URB MONTE BRISAS CALLE J
Practice Address - Street 2:A21
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3349
Practice Address - Country:US
Practice Address - Phone:787-863-4445
Practice Address - Fax:787-860-3070
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3944OtherPHARMACIST