Provider Demographics
NPI:1073197323
Name:PADILLA, JUAN CARLOS (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CORALIS
Mailing Address - Street 2:ESTANCIA DE MANATI
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-512-9672
Mailing Address - Fax:
Practice Address - Street 1:184 CARR 2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1860
Practice Address - Country:US
Practice Address - Phone:787-705-6204
Practice Address - Fax:787-705-6210
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist