Provider Demographics
NPI:1629672324
Name:CARR, NERILYN ABUTAN
Entity Type:Individual
Prefix:
First Name:NERILYN
Middle Name:ABUTAN
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NERILYN
Other - Middle Name:CAMBEL
Other - Last Name:ABUTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 THE CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8610
Mailing Address - Country:US
Mailing Address - Phone:831-624-0148
Mailing Address - Fax:
Practice Address - Street 1:6 THE CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8610
Practice Address - Country:US
Practice Address - Phone:831-624-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist