Provider Demographics
NPI:1154325835
Name:CARRANZA, PATTISUE (RPH)
Entity Type:Individual
Prefix:
First Name:PATTISUE
Middle Name:
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25299-A CANAL ROAD #6
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561
Mailing Address - Country:US
Mailing Address - Phone:251-981-2255
Mailing Address - Fax:251-981-2282
Practice Address - Street 1:25299-A CANAL ROAD #6
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561
Practice Address - Country:US
Practice Address - Phone:251-981-2255
Practice Address - Fax:251-981-2282
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist