Provider Demographics
NPI:1992392823
Name:CALVILLO, MAYRA L (PHARMD)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:L
Last Name:CALVILLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 COLLIER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-3588
Mailing Address - Country:US
Mailing Address - Phone:239-417-6647
Mailing Address - Fax:239-417-6653
Practice Address - Street 1:6800 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3588
Practice Address - Country:US
Practice Address - Phone:239-417-6647
Practice Address - Fax:239-417-6653
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist