Provider Demographics
NPI:1306175237
Name:SIERRA, CARMEN ENID (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ENID
Last Name:SIERRA
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:BOX 1379
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-0384
Mailing Address - Fax:787-735-0384
Practice Address - Street 1:CALLE JOSE VAZQUEZ AND DR. TROYER
Practice Address - Street 2:BO CAONILLAS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-735-0384
Practice Address - Fax:787-735-0384
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3323Other3323