Provider Demographics
NPI:1639698061
Name:SASTRE, CARLOS PEDRO
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:PEDRO
Last Name:SASTRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MCCUMBER LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9366
Mailing Address - Country:US
Mailing Address - Phone:302-373-5719
Mailing Address - Fax:
Practice Address - Street 1:263 QUIGLEY BLVD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-8112
Practice Address - Country:US
Practice Address - Phone:302-356-5600
Practice Address - Fax:302-356-5610
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA3-0000882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1528226362Medicaid
DE0844933Medicaid