Provider Demographics
NPI:1952772063
Name:CRANWELL-CALLEROS, CAROLINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:CRANWELL-CALLEROS
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 1:1374 CUERNAVACA CIRCULO
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3571
Mailing Address - Country:US
Mailing Address - Phone:650-641-0111
Mailing Address - Fax:
Practice Address - Street 1:871 SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4629
Practice Address - Country:US
Practice Address - Phone:650-618-6310
Practice Address - Fax:650-618-6311
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist