Provider Demographics
NPI:1043461106
Name:BOU, CARMEN PILAR
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:PILAR
Last Name:BOU
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:PILAR
Other - Last Name:BOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:VILLAS DE TINTILLO CALLE B #B-12
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1634
Mailing Address - Country:US
Mailing Address - Phone:787-783-4285
Mailing Address - Fax:787-793-4159
Practice Address - Street 1:B12 CALLE B
Practice Address - Street 2:VILLA DE TINTILLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1694
Practice Address - Country:US
Practice Address - Phone:787-783-4285
Practice Address - Fax:787-793-4159
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist