Provider Demographics
NPI:1063712776
Name:AVIS, CARLA CHRISTINA CASTILLO (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CARLA CHRISTINA
Middle Name:CASTILLO
Last Name:AVIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 W WASHINGTON ST BLDG F
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3264
Mailing Address - Country:US
Mailing Address - Phone:360-681-2120
Mailing Address - Fax:360-681-2962
Practice Address - Street 1:680 W WASHINGTON ST BLDG F
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3264
Practice Address - Country:US
Practice Address - Phone:360-681-2120
Practice Address - Fax:360-681-2962
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60151228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist