Provider Demographics
NPI:1356684955
Name:MELENDEZ, MARIE A
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:MELENDEZ
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 3 BOX 10430
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8028
Mailing Address - Country:US
Mailing Address - Phone:787-310-7690
Mailing Address - Fax:787-749-9435
Practice Address - Street 1:CARR. 19 KM 1.0 CENTRO COMERCIAL GARDEN HILLS
Practice Address - Street 2:1379
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-620-9616
Practice Address - Fax:787-749-9435
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6883183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician