Provider Demographics
NPI:1093223331
Name:CASTRO JORGE, KALICHA (AF)
Entity Type:Individual
Prefix:MRS
First Name:KALICHA
Middle Name:
Last Name:CASTRO JORGE
Suffix:
Gender:F
Credentials:AF
Other - Prefix:MRS
Other - First Name:KALICHA
Other - Middle Name:
Other - Last Name:CASTRO JORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AF
Mailing Address - Street 1:BO DULCE 78 CALLE PRINCIPAL
Mailing Address - Street 2:CAIMITO BAJO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0000
Mailing Address - Country:US
Mailing Address - Phone:844-347-7806
Mailing Address - Fax:
Practice Address - Street 1:MARGINAL SAN ROBERTO 996
Practice Address - Street 2:PROFESSIONAL OFFICE PARK V
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-0000
Practice Address - Country:US
Practice Address - Phone:844-347-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10088183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician