Provider Demographics
NPI:1831249796
Name:MALDONADO, CARMEN R (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:R
Last Name:MALDONADO
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 1:22 CALLE BETANCES
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2949
Mailing Address - Country:US
Mailing Address - Phone:787-894-2118
Mailing Address - Fax:787-894-2038
Practice Address - Street 1:22 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2949
Practice Address - Country:US
Practice Address - Phone:787-894-2118
Practice Address - Fax:787-894-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist