Provider Demographics
NPI:1104966852
Name:CARASIMA INC
Entity type:Organization
Organization Name:CARASIMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM/PRES
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-315-2056
Mailing Address - Street 1:AVENIDA RAFAEL CORDERO
Mailing Address - Street 2:17
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:07725
Mailing Address - Country:US
Mailing Address - Phone:787-737-3550
Mailing Address - Fax:787-737-3482
Practice Address - Street 1:CARR 181 KM 23 2
Practice Address - Street 2:BO CELADA
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-3550
Practice Address - Fax:787-737-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17F15523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085704OtherPK
PR5577800001Medicaid