Provider Demographics
NPI:1013374453
Name:CARRILLO, MARK SALCE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SALCE
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3314
Mailing Address - Country:US
Mailing Address - Phone:361-729-0530
Mailing Address - Fax:
Practice Address - Street 1:1409 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3314
Practice Address - Country:US
Practice Address - Phone:361-729-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist