Provider Demographics
NPI:1285774299
Name:CAMACHO, FATIMA (RPH)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:CAMACHO
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:P.O. BOX 362
Mailing Address - Street 2:STREET 307 CAMPO DEL MAR 4 B BOQUERON
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-255-3364
Mailing Address - Fax:787-255-6551
Practice Address - Street 1:STREET 101 KM 16.2 FARMACIA CUQUIMAR, INC
Practice Address - Street 2:
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622
Practice Address - Country:US
Practice Address - Phone:787-255-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist