Provider Demographics
NPI:1134409758
Name:CARRALERO, GINA MISHEL (PHARM D)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MISHEL
Last Name:CARRALERO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6382 GREEN MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3142
Mailing Address - Country:US
Mailing Address - Phone:904-880-0222
Mailing Address - Fax:
Practice Address - Street 1:3604 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5241
Practice Address - Country:US
Practice Address - Phone:904-778-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist