Provider Demographics
NPI:1013510544
Name:CARBAJAL, MARIA DOLORES (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1344
Mailing Address - Country:US
Mailing Address - Phone:617-763-7783
Mailing Address - Fax:
Practice Address - Street 1:1322 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3701
Practice Address - Country:US
Practice Address - Phone:617-731-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist