Provider Demographics
NPI:1164559563
Name:MELENDEZ, ANGEL L
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ST 31-29
Mailing Address - Street 2:URB SANTA ROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-261-0213
Mailing Address - Fax:
Practice Address - Street 1:TERRAZA PLAYERA CB-5 CAMINO DEL MAR
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00749
Practice Address - Country:US
Practice Address - Phone:787-261-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist