Provider Demographics
NPI:1114512977
Name:CASTILLO, DAWILMER (PHARMD, RPH, MS)
Entity Type:Individual
Prefix:DR
First Name:DAWILMER
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PHARMD, RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W 54TH ST APT 601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5318
Mailing Address - Country:US
Mailing Address - Phone:617-513-8436
Mailing Address - Fax:
Practice Address - Street 1:161 W 54TH ST APT 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5318
Practice Address - Country:US
Practice Address - Phone:617-513-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04165600183500000X
NY0679181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI04165600OtherBOP PHARMACIST
NY067918OtherNYS PHARMACIST LICENSE