Provider Demographics
NPI:1790105849
Name:ANGELUCCI, KARLA
Entity Type:Individual
Prefix:MISS
First Name:KARLA
Middle Name:
Last Name:ANGELUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CALLE VIDAL FELIX
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1817
Mailing Address - Country:US
Mailing Address - Phone:787-898-2525
Mailing Address - Fax:787-262-0289
Practice Address - Street 1:135 CALLE VIDAL FELIX
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1817
Practice Address - Country:US
Practice Address - Phone:787-898-2525
Practice Address - Fax:787-262-0289
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9642183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician