Provider Demographics
NPI:1023223948
Name:CAMPOS, GUILLERMO F (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:F
Last Name:CAMPOS
Suffix:
Gender:M
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0190
Mailing Address - Country:US
Mailing Address - Phone:787-744-6258
Mailing Address - Fax:787-743-0580
Practice Address - Street 1:AVE RAFAEL CORDERO FINAL ESQUINA TROCHE Y SANTIAGO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-0530
Practice Address - Fax:787-743-0580
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1461OtherPHARMACIST LICENSE