Provider Demographics
NPI:1346788320
Name:BAEZ, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BAEZ
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:RR 12 BOX 10223
Mailing Address - Street 2:RR 12
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:939-256-0220
Mailing Address - Fax:
Practice Address - Street 1:RR 12 BOX 10223
Practice Address - Street 2:RR
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9645
Practice Address - Country:US
Practice Address - Phone:939-256-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8422OtherPHARMACY TECHNICIAN
PR8422OtherFARMACIA