Provider Demographics
NPI:1205373230
Name:MELENDEZ-TIRADO, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MELENDEZ-TIRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 4464
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9643
Mailing Address - Country:US
Mailing Address - Phone:939-247-3193
Mailing Address - Fax:
Practice Address - Street 1:121 CALLE CRUZ ORTIZ STELLA S
Practice Address - Street 2:STREET
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3727
Practice Address - Country:US
Practice Address - Phone:787-285-0810
Practice Address - Fax:787-285-2664
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist