Provider Demographics
NPI:1376643866
Name:MERCADO, NIVIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NIVIA
Middle Name:
Last Name:MERCADO
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 1:22 CALLE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2209
Mailing Address - Country:US
Mailing Address - Phone:787-829-3305
Mailing Address - Fax:787-829-7187
Practice Address - Street 1:22 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2209
Practice Address - Country:US
Practice Address - Phone:787-829-3305
Practice Address - Fax:787-829-7187
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist