1700560026 NPI number — MARIELIE CARRASQUILLO PHARMACIST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700560026 NPI number — MARIELIE CARRASQUILLO PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRASQUILLO
Provider First Name:
MARIELIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRASQUILLO RIVERA
Provider Other First Name:
MARIELIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700560026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/24/2025
NPI Reactivation Date:
09/10/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 EUTAW PL BSMT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21217-4155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-201-1919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 REMINGTON AVE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-2128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  30360 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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