Provider Demographics
NPI:1821110511
Name:CARRASQUILLO, SULEICA
Entity Type:Individual
Prefix:
First Name:SULEICA
Middle Name:
Last Name:CARRASQUILLO
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:HC 1 BOX 11540
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-9629
Mailing Address - Country:US
Mailing Address - Phone:787-776-3599
Mailing Address - Fax:787-769-5353
Practice Address - Street 1:800 AVE RAFAEL HDEZ. MARIN STE 5
Practice Address - Street 2:FARMACIA AMIGA DE MONTECARLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5288
Practice Address - Country:US
Practice Address - Phone:787-762-1616
Practice Address - Fax:787-769-5353
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4559183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician