Provider Demographics
NPI:1033217120
Name:FELICIANO, CARMEN E (RPH)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:FELICIANO
Suffix:
Gender:F
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0490
Mailing Address - Country:US
Mailing Address - Phone:787-893-4914
Mailing Address - Fax:
Practice Address - Street 1:URB JARDINES DE YABUCOA
Practice Address - Street 2:CALLE 1 A8
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-6709
Practice Address - Fax:787-266-6505
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3204OtherRPH LICENSE