Provider Demographics
NPI:1417202771
Name:CASTRO, MIGUEL ADOLFO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ADOLFO
Last Name:CASTRO
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 1:4145 AVE ARCADIO ESTRADA
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-3203
Mailing Address - Country:US
Mailing Address - Phone:787-896-1040
Mailing Address - Fax:787-896-1222
Practice Address - Street 1:4145 AVE ARCADIO ESTRADA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3203
Practice Address - Country:US
Practice Address - Phone:787-896-1040
Practice Address - Fax:787-896-1222
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist