Provider Demographics
NPI:1801360896
Name:GUERRERO-DEHOSTOS, SULLYNETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SULLYNETTE
Middle Name:
Last Name:GUERRERO-DEHOSTOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 REEDYBROOK XING APT 9211
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-7601
Mailing Address - Country:US
Mailing Address - Phone:787-637-8296
Mailing Address - Fax:
Practice Address - Street 1:3914 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3412
Practice Address - Country:US
Practice Address - Phone:919-876-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist