Provider Demographics
NPI:1154108405
Name:CARPENTERO, RAUL ISIDRO JR (PHARMD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ISIDRO
Last Name:CARPENTERO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6973 CREEKVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5114
Mailing Address - Country:US
Mailing Address - Phone:907-359-1725
Mailing Address - Fax:
Practice Address - Street 1:5600 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2300
Practice Address - Country:US
Practice Address - Phone:907-339-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK211035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist