Provider Demographics
NPI:1376166926
Name:LAMEIRO BONILLA, CARMEN ALICIA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ALICIA
Last Name:LAMEIRO BONILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MUNOZ RIVERA
Mailing Address - Street 2:#64
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-738-0999
Mailing Address - Fax:787-263-8787
Practice Address - Street 1:MUNOZ RIVERA
Practice Address - Street 2:#64
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-5323
Practice Address - Fax:787-263-8787
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist