Provider Demographics
NPI:1598368003
Name:HURTADO-ESTRADA, CARLOS (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:HURTADO-ESTRADA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1837
Mailing Address - Country:US
Mailing Address - Phone:618-997-3155
Mailing Address - Fax:
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1837
Practice Address - Country:US
Practice Address - Phone:618-997-3155
Practice Address - Fax:618-998-1295
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist