Provider Demographics
NPI:1700560026
Name:CARRASQUILLO, MARIELIE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARIELIE
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:MARIELIE
Other - Middle Name:
Other - Last Name:CARRASQUILLO RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2330 EUTAW PL BSMT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4155
Mailing Address - Country:US
Mailing Address - Phone:787-201-1919
Mailing Address - Fax:
Practice Address - Street 1:2700 REMINGTON AVE STE 500
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-3043
Practice Address - Country:US
Practice Address - Phone:410-235-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2025-09-10
Deactivation Date:2025-06-24
Deactivation Code:
Reactivation Date:2025-09-10
Provider Licenses
StateLicense IDTaxonomies
MD30360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty