Provider Demographics
NPI:1346451424
Name:MELENDEZ, TANIA (AUX)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:AUX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 14274
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-9651
Mailing Address - Country:US
Mailing Address - Phone:787-224-3941
Mailing Address - Fax:787-857-4280
Practice Address - Street 1:CARR. 156 KM 13.4 BO. PALA HINCADO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-3980
Practice Address - Fax:787-857-4280
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4694183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician