Provider Demographics
NPI:1457246449
Name:DE JESUS CARRASQUILLO, REYNALDO JOSE (PHARMD)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:JOSE
Last Name:DE JESUS CARRASQUILLO
Suffix:
Gender:M
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:MIRADOR ECHEVARRIA CALLE FLAMBOYAN A3
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-738-7693
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE MAGNOLIA STE 2
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6301
Practice Address - Country:US
Practice Address - Phone:787-864-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist