Provider Demographics
NPI:1598413395
Name:CARABALLO ORENGO, RUSDALY (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUSDALY
Middle Name:
Last Name:CARABALLO ORENGO
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:HC 5 BOX 7535
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-374-1428
Mailing Address - Fax:
Practice Address - Street 1:CARR. 315 KM 1.0 AVE. FLAMBOYANES
Practice Address - Street 2:INTERSECCION AVE. 65 DE INFANTERIA
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-254-8151
Practice Address - Fax:787-899-2097
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist