Provider Demographics
NPI:1558972919
Name:CARRILLO, DULCE GABRIELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DULCE
Middle Name:GABRIELA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BLEIMEYER RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6918
Mailing Address - Country:US
Mailing Address - Phone:575-312-7476
Mailing Address - Fax:
Practice Address - Street 1:940 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1124
Practice Address - Country:US
Practice Address - Phone:575-524-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist