Provider Demographics
NPI:1366572497
Name:CARRASQUILLO, EDILBERTO
Entity type:Individual
Prefix:MR
First Name:EDILBERTO
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CALLE B
Mailing Address - Street 2:VITNAM
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00965-5221
Mailing Address - Country:US
Mailing Address - Phone:787-221-8811
Mailing Address - Fax:
Practice Address - Street 1:D32 CALLE MARGINAL
Practice Address - Street 2:EXTENCION FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5555
Practice Address - Country:US
Practice Address - Phone:787-620-9602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist