Provider Demographics
NPI:1871632679
Name:FERNANDEZ, CARLOS E (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:E
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
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 4498
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9604
Mailing Address - Country:US
Mailing Address - Phone:787-266-5142
Mailing Address - Fax:787-861-1056
Practice Address - Street 1:17 CALLE BARCOLO
Practice Address - Street 2:TU FARMACIA FAMILIAR
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707
Practice Address - Country:US
Practice Address - Phone:787-861-4855
Practice Address - Fax:787-861-1056
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4458183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician