Provider Demographics
NPI:1851511034
Name:GUILLAMA, CARMEN ISABEL (PH)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ISABEL
Last Name:GUILLAMA
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VIA ARCO IRIS PG 103 URB PACIFICA
Mailing Address - Street 2:URB PACIFICA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-399-4787
Mailing Address - Fax:787-282-6845
Practice Address - Street 1:PG103 VIA ARCOIRIS
Practice Address - Street 2:URB PACIFICA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6154
Practice Address - Country:US
Practice Address - Phone:787-399-4787
Practice Address - Fax:787-282-6845
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist