Provider Demographics
NPI:1194011379
Name:CASTANEDA, MERCEDES ELENA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:MERCEDES
Middle Name:ELENA
Last Name:CASTANEDA
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 1:1910 BOB BULLOCK LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-9733
Mailing Address - Country:US
Mailing Address - Phone:956-718-3236
Mailing Address - Fax:956-718-3231
Practice Address - Street 1:1910 BOB BULLOCK LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-9733
Practice Address - Country:US
Practice Address - Phone:956-718-3236
Practice Address - Fax:956-718-3231
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist