Provider Demographics
NPI:1245896190
Name:PAGAN MONSEGUR, CARLOS M (CPHT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:PAGAN MONSEGUR
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CALLE YAGUEZ
Mailing Address - Street 2:ESTANCIAS DEL RIO
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:939-865-0347
Mailing Address - Fax:
Practice Address - Street 1:608 CALLE YAGUEZ
Practice Address - Street 2:ESTANCIAS DEL RIO
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-0066
Practice Address - Country:US
Practice Address - Phone:939-865-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30036828183700000X
PR10312183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR188736OtherPHARMACY TECHNICIAN
PR30036828OtherPTCB