Provider Demographics
NPI:1629244801
Name:CASTRILLO, GLORIA (RPH)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:CASTRILLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:CORDERO-ROSADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:16281 ONEIDA PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2100
Mailing Address - Country:US
Mailing Address - Phone:954-680-5823
Mailing Address - Fax:954-680-5823
Practice Address - Street 1:13800 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1508
Practice Address - Country:US
Practice Address - Phone:954-442-3202
Practice Address - Fax:954-442-0602
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22622183500000X
PR3410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist