Provider Demographics
NPI:1942390471
Name:MORALES, CARMEN E (PH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:E
Last Name:MORALES
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 1:410 JOGLAR STREET
Mailing Address - Street 2:HERMANAS DAVILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5358
Mailing Address - Country:US
Mailing Address - Phone:787-785-0133
Mailing Address - Fax:787-787-3490
Practice Address - Street 1:246 CALLE COMERIO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5358
Practice Address - Country:US
Practice Address - Phone:787-785-3050
Practice Address - Fax:787-787-3490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1252OtherPROFESSIONAL LICENSE NUMB
PR049542OtherPROFESSIONAL REGISTRATION