Provider Demographics
NPI:1275894198
Name:CARMONA, CARLOS MANUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:CARMONA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6326
Mailing Address - Country:US
Mailing Address - Phone:405-329-5761
Mailing Address - Fax:405-329-5774
Practice Address - Street 1:333 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6326
Practice Address - Country:US
Practice Address - Phone:405-329-5761
Practice Address - Fax:405-329-5774
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist