Provider Demographics
NPI:1457654154
Name:CRUZ, MARIA CARMELA BUENAFLOR (RPH)
Entity type:Individual
Prefix:MS
First Name:MARIA CARMELA
Middle Name:BUENAFLOR
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SCUFFLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-7202
Mailing Address - Country:US
Mailing Address - Phone:864-458-8455
Mailing Address - Fax:
Practice Address - Street 1:202 SCUFFLETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7202
Practice Address - Country:US
Practice Address - Phone:864-458-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist