Provider Demographics
NPI:1043334493
Name:FALCON, MYNNETTE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:MYNNETTE
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JASMIN DD29 BORINQUEN GARDEN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 GRAN BOULEVARD PASEOS
Practice Address - Street 2:PASEOS GALLERY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6311
Practice Address - Country:US
Practice Address - Phone:787-283-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist