Provider Demographics
NPI:1659128536
Name:CISNEROS, CARLOS JOAQUIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JOAQUIN
Last Name:CISNEROS
Suffix:
Gender:M
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 1:103 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1007
Mailing Address - Country:US
Mailing Address - Phone:719-214-7637
Mailing Address - Fax:
Practice Address - Street 1:1017 N MARKET PLZ
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1502
Practice Address - Country:US
Practice Address - Phone:719-547-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist