Provider Demographics
NPI:1619238771
Name:ANTONETTY-CAMACHO, TATIANA A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:A
Last Name:ANTONETTY-CAMACHO
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:URB PUNTO ORO 4466 ALMEIDA ST
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2059
Mailing Address - Country:US
Mailing Address - Phone:787-644-9814
Mailing Address - Fax:
Practice Address - Street 1:URB PUNTO ORO 4466 ALMEIDA ST
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2059
Practice Address - Country:US
Practice Address - Phone:787-644-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist