Susan Carrasquillo
Individual provider Active NPI Pharmacist · Edgewater, FL
NPI 1013512607 · NPPES record last updated Dec 1, 2020
Key facts
- NPI
- 1013512607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS35593 (FL)
- Practice address
- 1806 S Ridgewood Ave
Edgewater, FL 32132-3600 - Phone
- (386) 423-4674
- NPI assigned
- Dec 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS35593 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS LLC | Past |
Accepting new patients | |
| Holiday CVS L.L.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS35593 | FL | Yes |
Addresses
Primary practice location
1806 S Ridgewood Ave
Edgewater, FL 32132-3600
Mailing address
1806 S Ridgewood Ave
Edgewater, FL 32132-3600
Other providers in Edgewater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.