Provider Demographics
NPI:1629527569
Name:CONDADO, CARINA ANDREA (RPH)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:ANDREA
Last Name:CONDADO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 CAMINO MANZANA
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2739
Mailing Address - Country:US
Mailing Address - Phone:505-662-7455
Mailing Address - Fax:
Practice Address - Street 1:1881 CAMINO MANZANA
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2739
Practice Address - Country:US
Practice Address - Phone:505-662-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist