Provider Demographics
NPI:1184825002
Name:AGENJO, CARMEN TERESA (BSPH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:TERESA
Last Name:AGENJO
Suffix:
Gender:F
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CALLE OROCOBIX
Mailing Address - Street 2:URB. CIUDAD CENTRO
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8703
Mailing Address - Country:US
Mailing Address - Phone:787-752-4195
Mailing Address - Fax:
Practice Address - Street 1:36 CALLE OROCOBIX
Practice Address - Street 2:URB. CIUDAD CENTRO
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8703
Practice Address - Country:US
Practice Address - Phone:787-752-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist