Provider Demographics
NPI:1366641557
Name:MENA, RAFAELA (RPH)
Entity Type:Individual
Prefix:
First Name:RAFAELA
Middle Name:
Last Name:MENA
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:PARK CT
Mailing Address - Street 2:MARACAIBO H-22
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2229
Mailing Address - Country:US
Mailing Address - Phone:787-616-0715
Mailing Address - Fax:
Practice Address - Street 1:PARK CT
Practice Address - Street 2:MARACAIBO H-22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2229
Practice Address - Country:US
Practice Address - Phone:787-616-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist