Provider Demographics
NPI:1235772369
Name:CARBON, LEONILA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LEONILA
Middle Name:
Last Name:CARBON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 E BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-5373
Mailing Address - Country:US
Mailing Address - Phone:671-637-9683
Mailing Address - Fax:671-637-3408
Practice Address - Street 1:199 E BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5373
Practice Address - Country:US
Practice Address - Phone:671-637-9683
Practice Address - Fax:671-637-3408
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPHO18183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist