Provider Demographics
NPI:1174055040
Name:CARRILLO, MILDRED (RPH)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:
Last Name:CARRILLO
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 1:13 CALLE GEORGETTI
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2712
Mailing Address - Country:US
Mailing Address - Phone:787-846-2410
Mailing Address - Fax:
Practice Address - Street 1:13 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2712
Practice Address - Country:US
Practice Address - Phone:787-846-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist