Provider Demographics
NPI:1982651055
Name:CARBALLEA, PURIFICACION
Entity Type:Individual
Prefix:MRS
First Name:PURIFICACION
Middle Name:
Last Name:CARBALLEA
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 1:11012 SW 38TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4440
Mailing Address - Country:US
Mailing Address - Phone:305-551-6027
Mailing Address - Fax:305-222-2084
Practice Address - Street 1:10401 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3745
Practice Address - Country:US
Practice Address - Phone:305-221-9657
Practice Address - Fax:305-222-2084
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist