Provider Demographics
NPI:1114153574
Name:CARRERO, BRUNILDA
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:CARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H.C. 58
Mailing Address - Street 2:BOX.12458
Mailing Address - City:AGUADA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00602
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 58 BOX 12458
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9718
Practice Address - Country:US
Practice Address - Phone:787-532-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4561183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2594286OtherTECHONOLOGY PHARMACY
PR2594286OtherPHARMACY