Provider Demographics
NPI:1750925897
Name:BRAVO, CARLOS MANUEL (PHARM D)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:BRAVO
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 1:345 JACARANDA CIR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7016
Mailing Address - Country:US
Mailing Address - Phone:941-485-1216
Mailing Address - Fax:
Practice Address - Street 1:345 JACARANDA CIR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7016
Practice Address - Country:US
Practice Address - Phone:941-485-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist