Provider Demographics
NPI:1700477759
Name:LANDINO, CARRIE LOUISE (R PH)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LOUISE
Last Name:LANDINO
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E SAN PATRICIO AVE
Mailing Address - Street 2:
Mailing Address - City:MATHIS
Mailing Address - State:TX
Mailing Address - Zip Code:78368-2347
Mailing Address - Country:US
Mailing Address - Phone:361-547-2577
Mailing Address - Fax:361-547-0778
Practice Address - Street 1:213 E SAN PATRICIO AVE
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-2347
Practice Address - Country:US
Practice Address - Phone:361-547-2577
Practice Address - Fax:361-547-0778
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty