Provider Demographics
NPI:1669839510
Name:CARABALLO, ALEXIS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 YAUCO PLAZA II
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4448
Mailing Address - Country:US
Mailing Address - Phone:787-267-6610
Mailing Address - Fax:841-396-3191
Practice Address - Street 1:601 YAUCO PLAZA II
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4448
Practice Address - Country:US
Practice Address - Phone:787-267-6610
Practice Address - Fax:841-396-3191
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-23
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist