Provider Demographics
NPI:1184819245
Name:CARMONA, EDGARDO R (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:R
Last Name:CARMONA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 CALLE INFANTA
Mailing Address - Street 2:VALLE REAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0506
Mailing Address - Country:US
Mailing Address - Phone:787-841-1883
Mailing Address - Fax:
Practice Address - Street 1:2188 EDUARDO RUBERTE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-844-1084
Practice Address - Fax:787-844-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR45611835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy