Provider Demographics
NPI:1598853053
Name:MALDONADO, CARLOS M (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO.RIO CANA CARRETERA 132 KM 22.1
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-290-1953
Mailing Address - Fax:787-290-1953
Practice Address - Street 1:HC 2 BOX 5377
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-9606
Practice Address - Country:US
Practice Address - Phone:787-290-1953
Practice Address - Fax:787-290-1953
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3248183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3248OtherLICENSE NUMBER