Provider Demographics
NPI:1164743951
Name:CARLOS, ADELA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ADELA
Middle Name:
Last Name:CARLOS
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:PO BOX 8682
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-8682
Mailing Address - Country:US
Mailing Address - Phone:671-637-1473
Mailing Address - Fax:671-637-1475
Practice Address - Street 1:2226 ARMY DR
Practice Address - Street 2:SUITE A
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6520
Practice Address - Country:US
Practice Address - Phone:671-637-1473
Practice Address - Fax:671-637-1475
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist