Provider Demographics
NPI:1699001453
Name:CASILLAS, IRIS M (RPH)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:M
Last Name:CASILLAS
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:HC 1 BOX 8017
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-9740
Mailing Address - Country:US
Mailing Address - Phone:787-780-2954
Mailing Address - Fax:787-798-2125
Practice Address - Street 1:CARR. 863 KM 2.0 BO. PAJARO
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-780-2054
Practice Address - Fax:787-798-2125
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist