Provider Demographics
NPI:1437678109
Name:CARABALLO, MARIA L
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:CARABALLO
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 1:316 COLLINSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3935
Mailing Address - Country:US
Mailing Address - Phone:585-797-3414
Mailing Address - Fax:
Practice Address - Street 1:7129 OKELLY CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6849
Practice Address - Country:US
Practice Address - Phone:919-674-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist