Provider Demographics
NPI:1033264478
Name:ORENDAIN, CARLOS EDWARD (PHARM BS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDWARD
Last Name:ORENDAIN
Suffix:
Gender:M
Credentials:PHARM BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9344 N EAGLESTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9305
Mailing Address - Country:US
Mailing Address - Phone:520-744-7519
Mailing Address - Fax:
Practice Address - Street 1:90 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2851
Practice Address - Country:US
Practice Address - Phone:520-364-7568
Practice Address - Fax:520-364-9053
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ8904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist